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
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...
