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:
Swoop & Squat Fails
The Only Solution to Fraud is to Take the Profit Out of the Crime
It Takes Courage to Fight the Fraudster
In Vivian Maritza Triana Marin, Sebastian Arroyave Penagos, and Daniel Arroyave Penagos v. Marc J. Paynter and Transport Marc Paynter Inc., No. 23-CV-6498, United States District Court, E.D. New York (July 10, 2026) Plaintiffs sued Defendants in diversity after a rear-end collision on the Whitestone Expressway in Queens, New York.
Commit Fraud and Suffer Consequences
Victims of Fraud Should Always Fight Back Proactively
Cross-Claim Against Fraudsters Successful
In Dual Diagnosis Treatment Center, Inc., et al. v. Health Net, Inc., et al., Health Net Life Insurance Company, B331260, California Court of Appeals, Second District, Third Division (July 16, 2026) a trial verdict in favor of Health Net and against Sovereign, a network of mental health and substance use disorder treatment centers, and Health Net, Inc., Health Net of California, Inc., Health Net Life Insurance Company, and Managed Health Network, Inc. (collectively, Health Net) was appealed to the California Court of Appeals.
More McClenny Moseley & Associates Issues
This is ZIFL’s forty-seventh 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. This is truly becoming a never-ending story.
Texas-based MMA Law Firm PLLC moved to protect owner and attorney John Zachary Moseley from a litigation funder suit during the firm’s bankruptcy.
Trouble at Lloyd’s
According to Claims Magazine, Lloyd’s corporate offices have stated that former CEO John Neal breached its compliance rules.
The Lloyd’s investigation found that Neal failed to disclose the relationship with the group’s former corporate affairs director Rebekah Clement.
The Great Jewel Theft
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.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Health Insurance Fraud Convictions
EyePoint Pharmaceuticals to Pay $4.6 Million to Resolve False Claims Act Allegations
Eyepoint Pharmaceuticals, Inc., (EyePoint) headquartered in Massachusetts, has agreed to pay the United States $ 4,657,463.18 to resolve allegations that it violated the False Claims Act by paying kickbacks to certain Ambulatory Service Centers (ASCs) to induce those ASCs to purchase and dispense DEXYCU, an injectable drug approved for the treatment of ocular inflammation following cataract surgery, between January 1, 2019 and March 1, 2023.
The Real Cost of Fraud
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 names and places of this true crime story were changed to protect the guilty.
New Jersey Consumer Fraud Act Now Covers Insurance Brokers, Agents, and Producers
On July 15, 2026, the New Jersey Supreme Court issued a decision overturning lower court rulings that had shielded “semi-professionals” — including insurance brokers, agents, and producers, among others — from regulation and litigation under the New Jersey Consumer Fraud Act (NJCFA).
Insurer Proactively Works to Defeat Fraud
RICO and PIP Fraud Not Subject to Arbitration in New Jersey
The Only Way to Defeat Fraud is to Eliminate the Fraudster’s Profit
In Allstate New Jersey Insurance Company, et al v. Carteret Comprehensive Medical Care, PC, d/b/a Monroe Comprehensive Medical Care, d/b/a Comprehensive Medical Care, d/b/a Fassst Sport, d/b/a Comprehensive Vein Care, Inimeg Management Company, Inc., et. al. Nos. A-74-24, A-75-24, A-76-24, No. 090337, Supreme Court of New Jersey (July 21, 2026).
Other Than Health Insurance Fraud Case
Nevada Businesswoman Sentenced to Prison for Fraudulent Scheme Seeking Millions in COVID-19 Tax Credits
Caused a Loss to the United States Exceeding $7 Million
Adonia Stiles, of Las Vegas, was a real estate agent, tax preparer, and clothing store owner.
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. He also serves as an arbitrator or mediator for insurance related disputes.
[email protected], http://www.zalma.com, http://zalma.com/blog
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Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.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 ...
Statutory Benefits vs. Rights of an Indispensable Party
Posted on July 31, 2026 by Barry Zalma
Post 5415
In Yairi Vazquez De La Cruz v. Pennsylvania Financial Responsibility Assigned Claims Plan, No. 413 EDA 2025, No. J-A10037-26, Superior Court of Pennsylvania (July 29, 2026) the court was called upon to decide if Yairi Vazquez de la Cruz, who was injured in an April 16, 2019 motor vehicle accident in Pennsylvania while riding in a vehicle driven by Carol Castro was entitled to benefits from the Pennsylvania Assigned Claims Plan.
The vehicle was owned and insured by Wineska Navarro-Agosta through American Independent Insurance Company (AIIC), but Castro was not listed as a driver on the policy.
Appellee obtained a default judgment against the at-fault party, but no responsible party had insurance from which she could recover. She then, because there was no way to collect from the responsible party, he sought benefits from the Pennsylvania Financial Responsibility Assigned Claims Plan.
LAW
Under 75 Pa.C.S. § 1752(a), a ...
Missing Insurance Check Resulted in More than 200 Page Pro Se Complaint
Post 5414
Defendants Needed to Wade Through a Thicket Of Background Detail And Evidentiary Matter” To Identify Which Specific Claims Are Brought Against Them
In Keith P. Sequeira et al. v. Metropolitan Life Insurance Company et al., Civil Action No. 25-1929 (RK) (JTQ), United States District Court, D. New Jersey (July 20, 2026) this matter is before the Court upon pro se Plaintiffs Keith P. Sequeira and Helen D. Sequeira’s (“Plaintiffs”) First Amended Complaint. (“FAC”).
Plaintiffs alleged claims arising from a missing $17,558.32 insurance check issued after water damage to their New Jersey home and from a later sheriff’s sale/foreclosure concerning that property. Their First Amended Complaint asserted hundreds of counts against numerous defendants, including insurers, mortgage-related entities, banks, law firms, attorneys, and public officials.
BACKGROUND:
Plaintiffs originally filed suit in the District of Columbia, after ...
Missing Insurance Check Resulted in More than 200 Page Pro Se Complaint
Post 5414
Posted on July 30, 2026 by Barry Zalma
Defendants Needed to Wade Through a Thicket Of Background Detail And Evidentiary Matter” To Identify Which Specific Claims Are Brought Against Them
In Keith P. Sequeira et al. v. Metropolitan Life Insurance Company et al., Civil Action No. 25-1929 (RK) (JTQ), United States District Court, D. New Jersey (July 20, 2026) this matter is before the Court upon pro se Plaintiffs Keith P. Sequeira and Helen D. Sequeira’s (“Plaintiffs”) First Amended Complaint. (“FAC”).
Plaintiffs alleged claims arising from a missing $17,558.32 insurance check issued after water damage to their New Jersey home and from a later sheriff’s sale/foreclosure concerning that property. Their First Amended Complaint asserted hundreds of counts against numerous defendants, including insurers, mortgage-related entities, banks, law firms, attorneys, and public officials.
BACKGROUND:
Plaintiffs originally filed suit...
