THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5276
Posted on February 2, 2026 by Barry Zalma
ZIFL – Volume 30, Issue 3
See the video at https://rumble.com/v752e4i-zalmas-insurance-fraud-letter-february-1-2026.html and at https://youtu.be/UmnGuRcLsz8
Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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/ This issue contains the following articles about insurance fraud:
Read the full 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
Disappearance of Defendant is Not Evidence of Death
In United States v. Marvin Moy, No. (S3) 22 Cr. 19 (PGG), United States District Court, S.D. New York (January 7, 2026) Defendant Marvin Moy, a medical doctor, was charged in the Southern District of New York with conspiracy to commit healthcare fraud, healthcare fraud, and conspiracy to commit money laundering. The indictment alleged that Moy aided co-conspirators in operating clinics that engaged in insurance fraud.
Read the full article and the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
More McClenny Moseley & Associates Issues
This is ZIFL’s forty first installment of the saga of McClenny, Moseley & Associates (MMA) 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. The saga of MMA has become a never-ending story.
“For the Final Time”: Federal Court Says MMA Firm Has “NO Rights” to Fees in Eastern District of Louisiana When a federal court says it is speaking “for the final time,” it’s usually worth paying attention.
Read the full article and the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
Repeat Offender Imprisoned For False Travel Insurance Claim in UK
Copywritten article available at:
Health Insurance Fraud Convictions
Prison Time For Healthcare Employees In Multimillion Dollar Adult Daycare Fraud Scheme
Dr. Osama Nahas, 70, McAllen, and Isabel Pruneda, 54, Edinburg, were found guilty on March 1, 2024, of conspiracy to commit healthcare fraud, healthcare fraud and conspiracy to violate the Anti-Kickback Statute following a two-week trial. Pruneda was also convicted for aggravated identity theft.
Read the full article and about dozens of convictions at the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
NCOIL Updates Anti-Fraud Model, Readopts ‘Storm Chaser’ Consumer Protections Model
According to A.M. Best, the National Council of Insurance Legislators updated its 30-year-old anti-insurance fraud model law and readopted the Storm Chasers Consumer Protection model act, which regulates contractors operating in the wake of a disaster.
The Insurance Fraud model act was updated to expand the definition of fraudulent acts, directly address contractor fraud, close criminal enforcement gaps and improve consumer protections, according to a weekly briefing by the Coalition Against Insurance Fraud.
Read the full article and the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
Other Than Health Insurance Fraud Convictions
Kansas Man Sentenced for Insurance and Identity Fraud
Marquez Gails, age 43, pleaded guilty on January 9, 2026, in Sedgwick County District Court to one felony count of fraudulent insurance act and one felony count of identity theft. Gails fraudulently used another individual’s identity to purchase a vehicle and auto insurance for the vehicle.
Read the full article and multiple convictions at the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
DOJ Announces That False Claims Act Settlements and Judgments Exceed $6.8B in Fiscal Year 2025
January 16, 2026 : Settlements and judgments under the False Claims Act exceeded $6.8 billion in the fiscal year ending Sept. 30, 2025, Deputy Attorney General Todd Blanche and Assistant Attorney General Brett A. Shumate, head of the Justice Department’s Civil Division, announced today. That amount is the highest in a single year in the history of the False Claims Act. This year, whistleblowers filed 1,297 qui tam lawsuits, the highest number in a single year, and the government opened 401 investigations, including matters announced as Administration policy objectives. Settlements and judgments since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $85 billion.
Read the full article and the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
The Tort of Bad Faith & Fraud
In the 1950s, the California Supreme Court created a tort new to U.S. jurisprudence: the tort of bad faith.
A tort is a civil wrong from which one person can receive damages from another for multiple injuries. The tort of bad faith was created because an insurer failed to treat an insured fairly, and the court felt that the traditional contract damages were insufficient to properly compensate the insured. The court allowed the insured to receive, in addition to the contract damages that the insured was entitled to receive under the contract had the insurer treated the insured fairly, damages for emotional distress and punitive damages to punish the insurer for its wrongful acts. Insureds, lawyers for insureds, regulators, and courts across the United States cheered the action of the California Supreme Court, for providing a fair remedy to abused insureds. Most of the states adopted the tort created by the California Supreme Court either by statute or court decision.
Read the full article and the 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law for more than 44 years as an insurance coverage and claims handling lawyer and more than 58 years in the insurance business. He is available at http://www.zalma.com and [email protected].
Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/
Follow Mr. Zalma on Twitter at https://twitter.com/bzalma. Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921.
Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/, https://gettr.com/@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.
The Largest Residential Burglary of All Time
Post 5407
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
Post 5397
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
Post 5396
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
Post 5421
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
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. 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...
