ZIFL – Volume 30, Issue 20 Subscribe to ZIFL here https://lnkd.in/gfpn78FM
Posted on October 15, 2026 by Barry Zalma
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
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 is written by Barry Zalma.
It is provided FREE to anyone who visits the site at https://lnkd.in/gVT5G9s
Six Insane Fraud Schemes the Trump Administration Has Uncovered Stealing from the taxpayer has now become a multi-billion-dollar industry in America. Obamacare has been a magnet for scammers.
Florida Insurance Agent Pleads Guilty in $300,000 Premium Finance Scheme
Daniel Raney, 41, who managed Raney Insurance and Raney Ventures in Pensacola, was arrested after AFCO Direct.
RIFE WITH FRAUD ALLOWS DEMANDS TO ESTABLISH RESTITUTION
Six Insane Fraud Schemes the Trump Administration Has Uncovered
Stealing from the taxpayer has now become a multi-billion-dollar industry in America – and the Trump administration is finally doing something about
From the Department of Government Efficiency to Vice President JD Vance’s task force, the Trump administration has made combatting fraud a top priority. Here are just a few of the most astonishing fraud schemes uncovered so far.
750,000 Fraudsters Stealing $2.2 Billion From Obamacare
Since its passage in 2010, Obamacare has been a magnet for scammers, resulting in higher tax bills for Americans and higher premiums in the private insurance market. But the Trump administration is finally doing something about it.
On September 21, Vice President Vance announced that the White House Fraud Task Force would be removing 750,000 enrollees from the program, saving taxpayers an estimated $2.2 billion.
Democrats never had an incentive to root out fraud; in fact, the Biden administration relaxed verification safeguards that would have caught most of the scammers.
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
Florida Insurance Agent Pleads Guilty in $300,000 Premium Finance Scheme
Daniel Raney, 41, who managed Raney Insurance and Raney Ventures in Pensacola, was arrested in August after the premium finance company, AFCO Direct, became suspicious, according to the arrest affidavit.
The Florida insurance agent faces years in prison after he pleaded guilty to fraudulently arranging more than $300,000 in premium financing for fake companies, then diverting much of the money to his personal use.
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
RIFE WITH FRAUD ALLOWS DEMANDS TO ESTABLISH RESTITUTION
Psychiatrist Convicted On Fourteen Fraud Counts And Restitution
Attorney Argument Without Evidence at Sentencing is Ineffective
In United States v. Gustavo Kinrys, Nos. 24-1592, 24-1716, United States Court of Appeals, First Circuit (September 21, 2026) Gustavo Kinrys, a Massachusetts psychiatrist, submitted fraudulent claims to private and public health insurers between 2015 and 2018, including claims for sessions that could not have occurred because he or the purported patient was abroad.
When insurers sought supporting records, he delayed, invoked a fictitious office manager, and created false documentation. A jury convicted him on fourteen of fifteen counts. The district court imposed a ninety-nine-month sentence, calculated intended loss at slightly more than $19 million using the face value of the bills, and ordered $6,537,309.59 in restitution.
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
Health Insurance Fraud Convictions
Maryland Long Term Care Pharmacy Pays $5.3M to Settle Allegations of Billing for Drugs Without Valid Prescriptions
Remedi SeniorCare Holding Corporation (Remedi), headquartered in Towson, Maryland, has agreed to pay over $5.3 million to the United States to resolve allegations that it violated the False Claims Act (FCA) by billing the Medicare and Medicaid programs for prescription drugs despite lacking valid prescriptions. The settlement is based on Remedi’s ability to pay and will be paid over time.
The United States alleged that, from Jan. 1, 2015 through March 31, 2021, Remedi submitted false claims to the Medicare and Medicaid programs for prescription drugs that lacked valid prescriptions and were dispensed to residents of assisted living facilities in various states.
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
Convicted of Insurance Fraud Seeks New Appointed Counsel & Mental Health
Denial Of Mental Health Diversion And Probation Condition Were Affirmed
In The People v. Nicholas Daniel Stiles, A173483, A173646, California Court of Appeals, First District, Second Division (September 29, 2026) Nicholas Daniel Stiles pleaded no contest to one count of insurance fraud arising from his purchase of automobile insurance after a June 2021 collision, and to grand theft arising from an April 2024 incident at a 7-Eleven.
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
Other Than Health Insurance Fraud Cases
Russian National Sentenced for Synthetic Identity Theft Fraud Scheme and Conspiring to Submit Fraudulent Voter Registrations
Dmitry Shushlebin, 45, a Russian citizen living in Miami Beach, Florida, was sentenced to six years in prison and three years of supervised release for organizing an identity theft fraud scheme that included efforts by the conspirators to submit fraudulent voter registrations. He was also ordered to pay $458,839.69 in restitution.
New Law in Ohio Targets Foreign Litigation
Ohio is cracking down on third-party litigation funding by banning investments from international funders, a move that could prevent larger funders, such as Burford Capital and Omni Bridgeway, from financing litigation filed in the Buckeye State.
The new Ohio law not only bans outside investments from foreign countries of concern but also bans investments with foreign ties.
The law, which goes into effect Oct. 6, impacts litigation filed in Ohio state courts but does not affect litigation filed in federal court.
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
BARRY ZALMA, ESQ, CFE
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455.
https://barryzalma.substack.com/welcome & https://zalma.com/blog & http://zalma.com/blog/wp-content/uploads/2026/09/ZIFL-09-15-2026.pdf
Read the full article and the 27 page issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Payment of Fines & Completion of Probation Reinstates Right to Vote
Post 4576
Posted on November 5, 2026 by Barry Zalma
To Restore Voting Rights The Felon Must Pay Fines of $546.00
In Florida Supreme Court Mediator Ethics Advisory Committee, ETH F-26-377, No. F-26-377 (October 29, 2026) citizen unnamed and to Ron Desantis Governor, Cord Byrd the Secretary of State Florida Division of Elections provided an advisory opinion to a convicted felon about his right to vote:
To: [redacted] We received your request for an advisory opinion. You indicate that you have one or more felony convictions and request whether you are eligible to vote, including whether you have any outstanding legal financial obligations under section 98.0751, Florida Statutes, and, if so, a statement of the amount that must be paid to make you eligible to vote, and an explanation of how the amount was calculated.
The Division hereby responds to your request pursuant to its legal authority under section 106.23(2), Florida Statutes, and Florida ...
Administrative Review Permits the Agency to Apply its Expertise
Post 4574
In Erwin Jordan Castro Valdez v. Warden, Otay Mesa Detention Center, No. 26-cv-06147-BAS-JLB, United States District Court, S.D. California (October 30, 2026) Castro Valdez, a Cuban national paroled into the United States, was arrested on June 23, 2026, for alleged insurance fraud, grand theft, and making a false report to law enforcement. In his first habeas action, the district court ordered a bond hearing within fourteen days to determine whether the changed circumstances justified revoking his parole.
An Immigration Judge subsequently denied bond because of his pending state criminal case. Castro Valdez filed a second petition under 28 U.S.C. § 2241, challenging that determination and requesting immediate release without first appealing to the Board of Immigration Appeals (BIA).
LAW
According to the supplied text, § 2241 does not expressly require administrative exhaustion, but courts impose exhaustion as a prudential requirement. ...
Insured’s Ordered to Pay Insurer for Fraud by the Insureds
Post 4573
Posted on November 3, 2026 by Barry Zalma
In The Prudential Insurance Company Of America v. Carol Gardina and George Gardina, No. 6:23-cv-1125-JSS-DCI, United States District Court, M.D. Florida, Orlando Division (October 22, 2026).
THE JURY TRIAL AND VERDICT
Plaintiff sued Defendants for numerous causes of action stemming from its allegations that Defendants fraudulently collected benefits under their long-term care insurance policies. Plaintiff's case proceeded to a nine-day jury trial, after which the jury found Defendants liable for fraudulent misrepresentation, fraudulent concealment, and civil conspiracy.
The jury also found Defendant Carol Gardina liable to Plaintiff for $1,930,129 in compensatory damages and Defendant George Gardina liable to Plaintiff for $12,496 in compensatory damages and $20 in punitive damages. Thereafter, the court entered judgment in Plaintiff's favor and awarded Plaintiff $1,930,129 in compensatory damages from...
