ZIFL – Volume 30 Number 5
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Read the full article at https://lnkd.in/gsD9eFea, see the full video at https://lnkd.in/gNiQ5zcw, https://lnkd.in/gnG8TAeT and at https://lnkd.in/gzjMXakw and at https://zalma.com/blog plus more than 5250 posts.
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:
ANTI-SLAPP MOTION STOPS CRIMINAL FROM ATTEMPT TO PROTECT HIS ASSETS FROM CONFISCATION
Convicted Criminal Seeks to Compel Receiver to Protect his Assets
The Work of a Court Appointed Receiver is Constitutionally Protected
In Simon Semaan et al. v. Robert P. Mosier et al., G064385, California Court of Appeals, Fourth District, Third Division (February 6, 2026) the Court of Appeals applied the California anti-SLAPP statute which protects defendants from meritless lawsuits arising from constitutionally protected activities, including those performed in official capacities. The court also considered the doctrine of quasi-judicial immunity, which shields court-appointed receivers from liability for discretionary acts performed within their official duties.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Interesting Report on Using the Alarm System to Gather Evidence
Subrogation: Utilizing Alarm Systems as a Silent Witness to the Loss available at Subrogation: Utilizing Alarm Systems as a Silent Witness to the Loss available at https://www.claimsjournal.com/sponsored/ids-research-development/2026/02/17/335635.htm
More McClenny Moseley & Associates Issues
This is ZIFL’s forty second 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.
In a November 10 2025 lawsuit in Travis County, Texas identifies Mr. Huye, late of MMA, as the Chief Operating Officer of McCullough Heating and Air Conditioning, LLC.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
“Lulling” is Important in Insurance Fraud Cases
“Lulling” is frequently found in cases involving financial crimes and insurance fraud. It was recognized by the US Supreme Court in 1974 in United States v. Thomas E. Maze, 14 U.S. 395, 94 S.Ct. 645, 38 L.Ed.2d 603, No. 72—1168 (Jan. 8, 1974). SCOTUS noted that when the defendant used subsequent mailings designed to lull the victims into a false sense of security, postpone their ultimate complaint to the authorities, and therefore make the apprehension of the defendants less likely than if no mailings had taken place it is evidence of fraud.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Health Insurance Fraud
Billing and Coding Abuses
Billing and coding abuses constitute a prevalent form of Medicare fraud. Providers intent on committing fraud intentionally submit inaccurate procedure or diagnosis codes to inflate reimbursements under the program's fee-for-service structure.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Health Insurance Fraud Convictions
Zynex, Inc. Agrees to Criminal Resolution Addressing Claims of Millions of Dollars of Health Care Fraud, Securities Fraud and Related Offenses
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Other Than Health Insurance Fraud Convictions
Kansas Man Sentenced for Insurance Fraud, Forgery
Larry Wilson, aged 54, pleaded guilty on December 11, 2025, in Reno County District Court to one felony count of insurance fraud, two felony counts for making false information, and two felony counts for forgery.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Coalition Against Insurance Fraud Announces New Leadership Appointments
The Coalition Against Insurance Fraud announced new leadership appointments across several of its committees and task forces, reinforcing its commitment to collaboration, innovation, and excellence in fraud prevention.
He Admitted He Did the Crime and Must Serve the Time
Fraud Perpetrators Have no Honor & First Circuit Affirms Sentence
In United States Of America v. Chang Goo Yoon, No. 24-1520, United States Court of Appeals, First Circuit (February 20, 2026) Chang Goo Yoon, a licensed physical therapist operating clinics in Massachusetts, engaged in a fraudulent scheme between November 2014 and November 2018. He submitted over a million dollars in false health insurance claims to private insurers, including Blue Cross Blue Shield and Aetna, as well as personal injury claims to MAPFRE, his own car insurer.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Insurance Fraud Bill Unanimously Passes Washington Senate
A bill intended to combat insurance fraud by updating a 20-year-old law passed the Washington state senate this week on a unanimous vote. Senate Bill 6031, which defines insurance fraud as its own crime, a Class B felony, was pushed for by Washington state Insurance Commissioner Patty Kuderer.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Barry Zalma
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455.
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. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
See the full article and the full March 1, 2026 issue at http://zalma.com/blog/wp-content/uploads/2026/02/ZIFL-03-01-2026.pdf
Dentist Who Defrauds His Insurer Can’t Pursue Bad Faith Claim
Post number 5295
Read the full article at https://www.linkedin.com/pulse/finding-fraud-voids-insurance-barry-zalma-esq-cfe-yizic, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.
In Andy Fletcher Montano v. The Dentists Insurance Company v. Dr. Sandy Fletcher Montano DDS, PLLC, Deer Park Dental, PLLC, No. 24-5202, United States Court of Appeals, Ninth Circuit (February 19, 2026) Sandy Fletcher Montano appealed pro se from the district court’s summary judgment in his diversity action against The Dentists Insurance Company (“TDIC”) alleging claims stemming from its denial of insurance coverage under a fraud clause in Montano’s policy.
ANALYSIS & DECISION
The Ninth Circuit concluded that the district court properly granted summary judgment on Montano’s claim for breach of contract because Montano ...
Declaratory Relief Granted to Insurer
Post number 5294
Suit for Defective Windows Excluded from Insurance
See the video at and at and at https://zalma.com/blog plus more than 5250 posts.
In Acuity v. Marion Glass And Mirror, Inc., No. 3:25-CV-00562-NJR, United States District Court, S.D. Illinois, Acuity, a mutual insurance company based in Wisconsin, filed a Complaint for Declaratory Judgment in the United States District Court for the Southern District of Illinois. Acuity sought a declaration that it has no duty to defend or indemnify its insured, Marion Glass and Mirror, Inc. (“Marion Glass”), in connection with a Third-Party Complaint brought by Samron Midwest Contracting, Inc. (“Samron”) in Williamson County.
Facts
The underlying lawsuit, filed in June 2023, involved allegations of property damage at the City of Marion’s Community Recreational Center due to allegedly faulty construction work ...
Neither Defense nor Indemnity Available Because of Exclusion
Post number 5293
See the video at and at and at https://zalma.com/blog plus more than 5250 posts.
You’re reading from the free part of Excellence in Claims Handling. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” button above.
Security at Low Income Housing to Risky for Insurer
In Everest Indemnity Insurance Company v. Kates Detective & Security Services Agency, Inc., et al., No. 25 C 5488, United States District Court, N.D. Illinois, Eastern Division (February 18, 2026) dealt with a clear and unambiguous exclusion.
Facts
Everest Indemnity Insurance Company sued Kates Detective & Security Services Agency, Inc. and the Chicago Housing Authority (CHA) seeking a ...
Contract Breaches that Allow Multiple Different Grounds to Make a Policy Void
More from Excellence in Claims Handling Substack for Subscribers Only. You can Subscribe to my substack at https://barryzalma.substack.com/subscribe
Posted on February 24, 2026 by Barry Zalma
You’re reading from the free part of Excellence in Claims Handling until you reach the paywall. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” link below.
If an insured breaches one or more material warranties and increases the risk covered by the policy, the contract may be voided by the insurer, depending on the jurisdiction. It is, therefore, essential that every claims investigation include efforts to establish compliance with every warranty.
In Cummings v. Fire Insurance Exchange, 292 Cal. App. 3d 1407, 249 Cal. Rptr. 568 (1988), the Court of Appeal ...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.
Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...
