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
Fraudsters Fight Over Ownership of the Subject of Their Fraud
Post number 5308
Read the full article at https://www.linkedin.com/pulse/honor-among-thieves-barry-zalma-esq-cfe-2nchc, see the full video at and at and at https://zalma.com/blog plus more than 5300 posts.
Convicted Fraudsters Try to Cheat Each Other
After failing to defraud insurers about the loss of a diamond ring the two admitted fraudsters sought possession of the seized ring which was neither lost nor stolen but was seized by the state.
In State Of North Carolina v. Kevin Ray Reece and Debra Lee Goldman, No. COA25-569, Court of Appeals of North Carolina (March 18, 2026) two fraudsters disputed the ownership of a platinum-banded diamond ring seized during a criminal investigation as the subject of Insurance Fraud.
FACTUAL BACKGROUND
Kevin Ray Reece pleaded guilty to two counts of felony obstruction of justice related to the ring and requested its return...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
