Zalma’s Insurance Fraud Letter Volume 29, Issue 5
The Source for the Insurance Fraud Professional
Post 5008
Read the full issue of Zalma's Insurance Fraud Letter for March 1, 2025 at https://lnkd.in/g9h3xuGn and https://lnkd.in/gGyuDaze, see the full video at https://lnkd.in/g6dJW9G5 and at https://lnkd.in/gtbchYPG, and at https://zalma.com/blog plus more than 5000 posts.
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Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the March 1, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
This issue contains the following articles about insurance fraud:
Auto Fraud Schemes
The Swoop and Squat
The swoop and squat auto insurance fraud is a deliberate attempt by a driver to claim auto insurance payouts by setting up an accident on the roads. These accidents usually involve an unsuspecting victim rear-ending the criminal, with at least an accomplice helping him.
In a swoop and squat auto insurance fraud, at least two people are involved. These two conspirators will scout the streets with their vehicles for their preferred target. Usually, a high value auto or a commercial vehicle will, more likely than not, be insured.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
California Department of Insurance Issues Warning About Tow Truck Scams
The California Department of Insurance issued a PSA with a warning for California drivers about an increase in scams involving tow truck companies targeting car accident victims where vehicles are being held hostage for cash. The scam has become prevalent in SoCal. See the video at https://x.com/i/status/1892004401218245112
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Heath Insurance Fraud Convictions
Man Convicted, Sentenced After Trial For Submitting False MassHealth Claims For Autism Behavioral Health Treatment
After Five-Day Trial, Defendant Found Guilty of Stealing More Than $33,000 in MassHealth Funds
Donald Martel, age 69, of Georgetown, was convicted after a five-day trial for fraudulently billing MassHealth, the state’s Medicaid program, for applied behavioral analysis (ABA) services that were never provided. Martel was sentenced to three years’ probation and ordered to pay full restitution, stay away from and have no contact with witnesses, and refrain from all work, billing, and responsibilities with MassHealth members.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-second installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
In MMA Law Firm, PLLC, formerly known as McClenny, Moseley & Associates, PLLC v. PCG Claims, LLC d/b/a PCG Consulting, LLC, No. 01-24-00217-CV, Court of Appeals of Texas, First District, Houston (December 31, 2024), A Law Firm filed a Suggestion of Bankruptcy informing this Court that appellant filed a petition for Chapter 11 bankruptcy in Case Number 24-31596 in the United States Bankruptcy Court for the Southern District of Texas.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
COMPACT BOOK OF ADJUSTING PROPERTY CLAIMS FOURTH EDITION
In Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
Two Washington State Residents Guilty of Insurance Fraud
Jason Weisfeld of Federal Way, Washington, and Fedaa Shakir, pleaded guilty to submitting false insurance claims. A carpet-cleaning claim and a fake theft of a Hyundai has led to guilty pleas for the two people for insurance fraud in Washington.
Weisfeld filed a false insurance claim relating to a carpet cleaning incident that resulted in an investigation by the Washington State Insurance Commissioners’ Investigations Unit.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Deterring Insurance Fraud
A New Book on Insurance Fraud and How the DOJ Deters and Defeats Insurance Fraud.
INSURANCE FRAUD IS EPIDEMIC
Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. No one knows the amount that is taken by insurance fraud because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $308 billion to more than $500 billion every year. The only certainty is that it is a serious crime that bleeds the insurance industry sufficiently to have states compel insurers to create special investigative units (SIU’s) to investigate, deter and defeat insurance fraud to assist the state in its efforts to prosecute the crime.
The book is now available as a Kindle book, a paperback and hardcover at amazon.com
RED FLAGS OF FRAUD
Suspicious claims have common attributes. Insurers and their anti-fraud organizations have collated the common attributes into lists of indicators or red flags of fraud. The lists were created as training aids and to be used to determine whether further investigation is required to determine if a claim is legitimate or false and fraudulent.
Continually growing, these lists are known as the “red flags” or “indicators” of fraud lists. There are many different categories, ranging from those associated with the claim itself or with insureds to indicators of specific types of fraud, such as bodily injury fraud or arson for profit.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
BARRY ZALMA
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog.
He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Read the full article and the full 18 page ZIFL at https://zalma.com/blog/wp-content/uploads/2025/02/ZIFL-02-15-2025.pdf
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Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
The Largest Residential Burglary of All Time
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Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma
See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
After ...
Chutzpah is not Enough
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Posted on July 20, 2026 by Barry Zalma
See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX
Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.
In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”
As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.
LAW:
The ...
Fraud Shouldn’t Pay
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See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ¬¬¬Perpetrators than any Other Crime.
The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.
One month after the policy was ...
Day Care Owner Loses Subsidies Because She Criticized State
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Posted on August 11, 2026 by Barry Zalma
First Amendment Right Will be Allowed to Go to Trial
In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.
She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...
Rescission for Material Misrepresentation
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Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.
DISCUSSION/ANALYSIS:
As a result, the...
