Zalma’s Insurance

Fraud Letter

The Essential Resource For The Insurance Fraud Professional

A ClaimSchool ™ Publication, Written by Barry Zalma, Esq., CFE © 2017 ClaimSchool, Inc. & Barry Zalma

Volume 21, No. 16August 15, 2017

Go to Zalma Books – E-Books and Articles by Barry Zalma –http://www.zalma.com/zalmabooks.htm Go to my: Zalma’s Insurance 101 at http://www.zalma.com/videoblog Go to: Insurance Law Commentary by Barry Zalma at http://zalma.com/insvideo

Subscribe to e-mail Version, it’s Free! –http://www.zalma.com/ZIFL-CURRENT.htm

Go to my blog: Zalma On Insurance at http://zalma.com/blog

Quote of the Issue

“Laws which prescribe what everyone must believe, and forbid men to say or write anythingagainst this or that opinion, are often passed to gratify, or rather to appease the anger of

those who cannot abide independent minds.”

Baruch Spinoza

Attorney General Sessions Announces Opioid Fraud and Abuse Detection Unit

The U.S. Department of Justice announced on August 2, 2017 the formation of a new OpioidFraud and Abuse Detection Unit. According to Attorney General Jeff Sessions, the new unit,which is part of a pilot program, will utilize data analytics “to identify and prosecute individualswho are contributing” to the opioid epidemic. The Department will also fund additionalprosecutors tasked specifically with investigating and prosecuting opioid-related health care fraud.

Speaking at the Columbus Police Academy today, Attorney General Sessions said that the newOpioid Fraud and Abuse Detection Unit will focus specifically on opioid-related health care fraudusing data to identify and prosecute individuals that are contributing to this prescription opioid

epidemic.

The prosecutors’ work will include targeting and prosecuting doctors, pharmacies, and medical providers who, according to AttorneyGeneral Sessions, “are using this epidemic to line their pockets.”

Additionally, as part of the program, the Department will fund twelve experienced Assistant United States Attorneys for a three year termto focus solely on investigating and prosecuting health care fraud related to prescription opioids, including pill mill schemes andpharmacies that unlawfully divert or dispense prescription opioids for illegitimate purposes.

The following districts have been selected to participate in the program:

• Middle District of Florida,

• Eastern District of Michigan,

• Northern District of Alabama,

• Eastern District of Tennessee,

• District of Nevada,

• Eastern District of Kentucky,

• District of Maryland,

• Western District of Pennsylvania,

• Southern District of Ohio,

• Eastern District of California,

• Middle District of North Carolina, and

• Southern District of West Virginia.

In his speech, the Attorney General discussed the new program:

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“First, I am announcing a new data analytics program – the Opioid Fraud and AbuseDetection Unit. I have created this unit to focus specifically on opioid-related healthcare fraud using data to identify and prosecute individuals that are contributing tothis opioid epidemic. This sort of data analytics team can tell us importantinformation about prescription opioids—like which physicians are writing opioidprescriptions at a rate that far exceeds their peers; how many of a doctor’s patientsdied within 60 days of an opioid prescription; the average age of the patientsreceiving these prescriptions; pharmacies that are dispensing disproportionately largeamounts of opioids; and regional hot spots for opioid issues.

“With this data in hand, I am also assigning 12 experienced prosecutors to focus solely on investigatingand prosecuting opioid-related health care fraud cases in a dozen locations around the country wherewe know enforcement will make a difference in turning the tide on this epidemic. These prosecutors,working with FBI, DEA, HHS, as well as our state and local partners, will help us target and prosecutethese doctors, pharmacies, and medical providers who are furthering this epidemic to line their pockets.These prosecutors will be based in several states across the country, including Kentucky, WestVirginia, Tennessee, and right here in Southern Ohio.

“With these new resources, we will be better positioned to identify, prosecute, and convict some of theindividuals contributing to these tens of thousands of deaths a year. The Department is determined toattack this opioid epidemic, and I believe these resources will make a difference.”

The new directive from Attorney General Sessions signals a renewed focus by the Department to prosecute traditionally white collaroffenses, like health care fraud, if they can be linked to the larger drug epidemic. Doctors, pharmacists, and others involved in prescribingand dispensing opioids should continue to be diligent in their efforts to comply with applicable federaland state laws and should consult counsel if they have questions or in the event they are contacted bylaw enforcement.

For additional information, including the full remarks of the Attorney General, on the Department ofJustice’s new Opioid Fraud and Abuse Detection Unit, seehttps://www.justice.gov/opa/pr/attorney-general-sessions-announces-opioid-fraud-and-abuse-detection-unit.

Readers of ZIFL are aware of the minimal efforts the Department of Justice have used to defeat healthinsurance fraud and the fact that there are many states where there is no federal effort to defeat healthinsurance fraud. This new effort is encouraging and ZIFL hopes it will act to bring about more prosecutions and convictions.

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Zalma's Insurance Fraud Letter -- Page 2 of 17

Fugitive From Trial Must Serve 27 Years for Insurance Fraud

It Doesn’t Pay to Run Before Trial Complete

Regardless of the public’s belief, insurance fraud is a serious crime. Perpetrators of insurance fraud think,perhaps because of its reputation, that the crime is not serious enough to be exposed to a major jail sentence.They are wrong.

In Worthen v. The State, A17A0949, SE-029C, Court of Appeals of Georgia (August 3, 2017) the Court ofAppeal of Georgia was faced with an appeal by Tobias Worthen who sought to set aside his convictions forinsurance fraud, two counts of theft by deception, making a false statement, and false report of a crime.

Worthen, in an amazing expression of legal chutzpah complains about various waivers of his rights thatoccurred after he absconded during the middle of his trial. He also argues that he is entitled to a new trial basedupon the absence of a complete trial transcript.

FACTS

The record shows that Worthen’s trial began on March 31, 2015, with a senior judge presiding. On the fourth day of trial, Worthen failed toreturn to court, and the trial court issued a bench warrant for his arrest. The trial continued in his absence, and the jury found him guilty ofall charges. On April 6, 2015, the senior judge sentenced Worthen to serve a total of 27 years.

On April 14, 2015, a different judge signed an order prepared by Worthen’s counsel which granted his request for a transcript at publicexpense. The first sentence of the order incorrectly stated that Worthen “continues to be indigent and incarcerated after being sentenced bythis Court on April 6, 2015,” when in fact Worthen “remained an unapprehended fugitive until May 1, 2016 – more than a year followinghis conviction.” (Emphasis supplied.) The order was entered because the judge was not advised that Worthen was a fugitive.

After learning that Worthen had absconded during a trial over which the senior judge had presided, the judge set aside her order granting atranscript and denied a subsequent request by Worthen for a free transcript.

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On May 25, 2016, the trial court held a status conference in which counsel for both parties and Worthen were present. In this conference,the trial court “informed the parties that it appeared that the Defendant’s Motion for New Trial was subject to dismissal due to its havingbeen filed while the Defendant was a fugitive.”

Worthen contends that there was no valid waiver of his right to be present at sentencing, arguing that the State failed to prove a valid,intelligent and knowing waiver. In Worthen’s view, the State must prove that he knew he was waiving his right to be present at sentencingif he absented himself from the trial.

DISCUSSION

It is well-established that if a trial has begun in the defendant’s presence and he voluntarily absentshimself, this does not nullify what has been done or prevent the completion of the trial, but, on thecontrary, operates as a waiver of his right to be present and leaves the court free to proceed with the trialin like manner and with like effect as if he were present.

Commonly known as the “fugitive disentitlement doctrine,” this equitable doctrine limits access tocourts by fugitives from justice. Aside from the difficulty of enforcing a judgment against a fugitive,other rationales underlying the doctrine include promoting the efficient operation of the courts,discouraging flights from justice, and avoiding prejudice to the other side caused by the appellant’sfugitive status.

Georgia law is clear that where a defendant becomes a fugitive before filing any post-convictionmotions and then remains a fugitive during the time in which he could assert such a motion, he waiveshis right to seek post-conviction relief.

The Supreme Court of Georgia explained over a century ago, ‘a fugitive defendant does not have a right to appear by counsel until he hasreturned into custody.’” Additionally, no due process violations are implicated in dismissals under this doctrine. See Goeke v. Branch, 514U. S. 115, 118-119 (115 SCt 1275, 131 LEd2d 152) (1995); Allen v. Georgia, 166 U. S. 138 (17 SCt 525, 41 LE2d 949) (1897); BrownRicketts, 235 Ga. 29 (218 SE2d 785) (1975).

The fact that Worthen was captured before the trial court dismissed the motion for new trial filed by his attorney does not preclude itsapplication.

Worthen waived his right to seek a new trial because he remained a fugitive during the entire time in which he could have filed a motionfor new trial.

ZIFL OPINION

“Chutzpah” is a Yiddish term that means unmitigated gall. The basic definition is a person who kills his parents then pleads for mercybecause he is an orphan. To seek a new trial because he was a fugitive from justice is chutzpah. He received and deserved the sentence hereceived and will serve, hopefully, most of the 27 years he was sentenced to serve.

Books from Barry Zalma

“Insurance Law”

Quick Overview

Insurance Law is the most comprehensive, and yet practical, insurance law authority available today. Written by nationally-renownedinsurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness and blogger,Insurance Law introduces the new insurance professional to the fundamental principles of insurance and providesthe experienced litigator analyses of today’s leading insurance law decisions nationwide.

Insurance Law is the most comprehensive, and yet practical, insurance law authority available today.

This book is ideal for any professional who works in or frequently interacts with the insurance industry. Claimsprofessionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), business owners, andstudents will benefit greatly from this all-inclusive reference. It is also the perfect resource for educators andtrainers whose role requires an understanding of insurance law.

In addition to case law, the author has provided countless citations to relevant statutory, regulatory, and judicialsources which are guaranteed to kickstart your research.

http://www.nationalunderwriter.com/insurance-law.html

Additional books at the Zalma Insurance Claims Library

http://www.nationalunderwriter.com/reference-bookstore/property-and-casualty/zalma-insurance-claims-library.html

In addition the standard FC&S Online published by The National Underwriter Company now includes a Fraud Channel with the majorityof the information taken from my work on insurance fraud. It is available at http://www.nationalunderwriterpc.com/Pages/default.aspx. The

Zalma's Insurance Fraud Letter -- Page 4 of 17

Fraud Channel covers issues like: Fraud Basics, Checklists and Charts, Investigation, Ethics, Reference Materials, Fraud Of The Week, and both the full text and summaries of insurance fraud Cases.

California DOI Accuses Access Insurance CompanyIn a press release issued August 2, 2017, The California Department of Insurance (CDOI) announced that it issued anOrder to Show Cause, Accusation, and Notice of Noncompliance charging Access Insurance Company and some of itsaffiliates with engaging in improper claims handling and improper rating and underwriting practices in violation of theCalifornia Insurance Code and the Fair Claims Settlement Regulations.

The CDOI reported that Insurance Commissioner Dave Jones said: “Consumers should have confidence that anyoneselling them insurance in California is complying with our consumer protection laws. Making sure insurancecompanies deliver on their promises to consumers is a critical part of the department’s mission.” In addition the CDOI

reported:

In response to numerous consumer complaints about Access’ business practices, the department launched aninvestigation that revealed over 40 different alleged statutory and regulatory violations. The alleged violations in theOrder to Show Cause and Accusation include misrepresentation of pertinent facts to claimants, failure to acknowledgeand act reasonably promptly, and failure to adopt and implement reasonable standards for the prompt investigation andprocessing of claims arising under insurance policies.

The Notice of Noncompliance alleges Access’s rating plans, rating systems, rates and underwriting guidelines, and theirimplementation by Access and its affiliates violated California law. These allegations include cancelling policies forreasons not permitted by law, failure to give appropriate discounts, and overcharging consumers forcertain fees.

In addition to suspension of Access’s Certificate of Authority, the Order to Show Causeseeks monetary penalties against Access and its affiliates of up to $5,000 for each allegedviolation, or if the act was willful, up to $10,000 and an order requiring Access to ceaseand desist from further engaging in methods, acts or practices that are unfair and deceptivewithin the meaning of the Unfair Practices Act and Fair Claims Settlement Regulations.

The Notice of Noncompliance requires Access to correct any unlawful practices within 10days of receiving the notice. For each allegation, Access must also show proof ofcompliance or correction. If Access fails to comply within the allotted time the departmentwill set a public hearing and if the commissioner finds Access to be in violation, he mayorder payment of monetary penalties and other appropriate corrective action.

SCFIA- Fraud Investigators Conference- October 3-5, 2017- Palm Springs

Southern California Fraud Investigators’ Association

SCFIA Annual Conference October 3-5, 2017

The 2017 SCFIA( <http://www.scfia.org> www.scfia.org) Conference this year is set for October 3- 5,2017 and will be held at the Riviera Palm Springs Hotel. ( <http://www.rivierapalmsprings.com>www.rivierapalmsprings.com)

Reduced room rates are only valid up through September 15th.

The speakers are from the Los Angeles, Orange, Riverside and San Bernardino District Attorney’s office aswell as from the Department of Insurance Fraud Division and NICB. POST is pending approval for 19hours for this conference. Also CEU’s and MCLE are pending as well.

2017 - SCFIA ( <http://www.scfia.org> www.scfia.org ) Conference Schedule follows:

Zalma's Insurance Fraud Letter -- Page 5 of 17

Topic of Presentation Presenter

Elder Abuse for 1st Timers Sgt. Dana McCants - LASO

ID Epidemic - Detection, Cures, & Prevention Sgt. Richard Floyd - LASO

Real Estate Fraud 101 Sgt. Alex Gilinets & Edward Navarro - LASO

Fraudulent Detection Training Document Sgt. Jimmy Gomez- DMV

Evaluating Truthfulness & Credibility David Boone - Fiveby5 Intelligence Group Inc.

Understanding the Complexity of Fire Investigations Michael Koster- Reliant Investigations

Why Must I Call a Fire “Undetermined”? John Kitchens- Case Forensics

Fire & Explosion Investigations that Sizzle Ulises Castellon - FCA & Doug Wood- L/O of Clark Hill

Elder Financial Fraud & Abuse Debra Allen - Allen Investigations

Surveillance 101 Paul Netto- Western Limited

The Art of Background Checks in a Fraud Investigation Oleg Flaksman - O&O Investigations Inc.

Vehicle Telematics & Infotainment Systems - New Era of DataCollection

Brendon Morse- ARCCA & Dr. James Mason

Evaluating Documents for Potential Fraud - Trust but Verify Richard Harer- Specialized Investigations & Kevin Hansen-L/O ofMcCormick Barstow

Interviewing Techniques for Medical Professionals Christopher Robbins - OCDA

Insurance Fraud Current Trends Mike Kelly - National Insurance Crime Bureau

Complex Capping Schemes Teena Barton- ICW Group & Jennifer Friedl- OC DA

Using Data Analytics to Uncover Provider Fraud Lane Spencer- State Fund SIU

Inside Perspective to Treatment Recovery Fraud Detective Chris Luistro & Polli Pent - DOI

The Evolution of Staged Collision Detective Don Shoham- DOI

Worker’s Compensation Claimant Fraud Rebekah McClain & Ruben Lino - DOI

Social Media Sgt. Brian Farnsworth - DOI

Resolving Suspect Uninsured Motorist Claims Jon Colmon- Colman Law Group & Ken Oswald- Access GeneralInsurance

Practical Suggestions for How to Take Effective RecordedStatements

Melody Mosley- L/O of Melody Mosley & Brian Mizell- L/O ofMcDowell, et al

Building a Case for Public Works Prosecution Donde McCament - Orange County DA

The Working Relationship Between the DA & SIU Mark Magill - Riverside County DA

Compound Medication Billing Fraud Sgt. Vladislav Mikulich- LASO

ID Theft & Medical ID Theft Mike McKee - National Insurance Crime Bureau

Automobile Fraud Filing Don Tamura - LADA

Brave new World - Using SB 1160 & AB 1244 to Fight Worker’sComp Fraud

James Fisher- Division of Industrial Relations- State of California

Current Trends in Worker Compensation Fraud Stephane Weissman - RIV DA

Identifying Fraud in MVA and slip/trip/fall Claims Adam Cyr - ARCCA & Brendan Morse- ARCCA

Automotive Forensic Technology & Security Chad Tredway-North American Technical & Forensic Services

Zalma's Insurance Fraud Letter -- Page 6 of 17

Fraudulent Contractors - What You Need to Know Rebecca Lyke - Contractors License Board- State of California

Investigators can sign up for the 2.5 days of the conference or 1 day if they decide. There will also be a casinonight as well as a silent auction benefitting a local charity. Conference registration is<http://scfia.org/events/conference/information/> http://scfia.org/events/conference/information/ Theconference will offer approximately 19 hours of POST and CEU. Currently we are waiting for approval forPOST, CEU and MCLE credits. Discounts are available for some associations such as(CALI, NICB, NCFIA,ASIS) members and for 5 or more from the same company. Please go to SCFIA website at<http://www.scfia.org> www.scfia.org for additional information and for registration.

If interested in sponsoring or being a vendor please contact Brian Mizell at<mailto:bmizell@mcdowelllaw.com> bmizell@mcdowelllaw.com or Dan Everakes at <mailto:deverakes@colmanlawgroup.com>deverakes@colmanlawgroup.com or if you wish to donate to casino night please contact <mailto:dwilliams@dcwpi.com>dwilliams@dcwpi.com . We are also looking for sponsors for the hospitality room. If interested please contact Bill Antkiewicz at310-463-8423 or email him at <mailto:antkie@att.net> antkie@att.net

Otherwise all conference information is posted at <http://www.scfia.org> www.scfia.org.

Barry Zalma Speaks at Your RequestA speaker on insurance, insurance claims handling, and insurance for any event at a reasonable cost at yourlocation or by video. Go to Barry Zalma Speaks at Your Request click on link for details.

E-Books from Barry Zalma

Heads I Win, Tails You Lose - 2017

This E-book started as a collection of columns insurance consultant, expert witness and insurance lawyer BarryZalma wrote and published in the magazines “Insurance Journal,” “Insurance Week,” and “The John CookeInsurance Fraud Report.” It now contains 87 fictional stories on how insurance fraud is perpetrated by changing thenames and places of the incident to protect the guilty.

Since the last edition I have added more stories that were published in my twice monthly newsletter, Zalma’sInsurance Fraud Letter which is available free to anyone who clicks the link and a brief analysis of the CaliforniaSpecial Investigation Unit Regulations. In addition the e-book has been totally rewritten correcting typographical andsyntax errors.

The title, “Heads I Win, Tails You Lose” is meant to describe insurance fraud as it works in the United States. Whenever a person succeedsin perpetrating an insurance fraud everyone who buys insurance is the loser. If the fraud succeeds the insurer must charge more premium tocover the expense of defending the fraud and payment of funds to the fraud perpetrator. If the fraud fails the insurer must still charge morepremium to cover the expense of defending the fraud.

Everyone, except the lawyers and fraud perpetrators, lose.

After you make a payment through PayPal, please wait for the article to upload to your machine. If you have a problem with the purchaseplease write to me at zalma@zalma.com.

Insurance Fraud and Weapons to Defeat Fraud

Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain numberbecause most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion tomore than $300 billion every year.

Insurers and government backed pseudo-insurers can only estimate the extent they loseto fraudulent claims. Lack of sufficient investigation and prosecution of insurancecriminals is endemic. Most insurance fraud criminals are not detected. Those that aredetected do so because they became greedy, sloppy and unprofessional so that theattempted fraud becomes so obvious it cannot be ignored.

No one will ever be able to place an exact number on the amount lost to insurancefraud. Everyone who has looked at the issue knows – whether based on their heart, theirgut or empirical fact determined from convictions for the crime of insurance fraud –that the number is enormous.

When insurers and governments put on a serious effort to reduce the amount of insurance fraud the number of claims presented to insurersand the pseudo-government-based or funded insurers drops logarithmically.

Zalma's Insurance Fraud Letter -- Page 7 of 17

The e-book contains the full text of the most important insurance fraud cases in over 2000 pages of material essential to every insurancefraud professional.

Available at http://www.zalma.com/zalmabooks.htm

Getting the Whole Truth

The interview is an essential form of fact gathering for every type of human interaction. Interviews happen everywhere; they are performedby almost everyone. Interviewing is also an art, and the most effective interviews are conducted by those who are knowledgeable andskilled in this art.

The purpose of an interview is to uncover the truth; the method of uncovering the truth is the art of theinterview. The standard interview does not have, nor should it be given, the pejorative sense conveyed by theexpression “giving someone the third degree.” Interview professionals do not use rubber hoses or hot lights, orsubject the interviewee to torture. In their limited arsenal, professionals do not have the power of the state, thereputation of the FBI, the majesty of a court trial, nor the intimidation of a search warrant.

Civil interviewing professionals are, therefore, compelled to get the information they need by intelligence, wit,skill, and experience. They must be masters of the social graces; they must know how to put people at ease. Theskill of the professional causes the person being interviewed to actually want to give information to theinterviewer. When the interview is successful, the subject becomes a virtual partner with the professional in the

effort to uncover the truth, the whole truth, and nothing but the truth.

This ebook will help anyone who needs to obtain information from anyone else gain the information needed whether a business person,reporter, interviewer, investigator or lawyer.

The book will be delivered to you by e-mail shortly after purchase.

Random Thoughts on Insurance - Vol. IV

Since 2010 I have been writing a blog post at least five days a week. This e-book is a collection of those posts that reveal my interest ininsurance case law. Some of the cases reviewed were important. Some were of first impression. Others will be totally unimportant. Allwere interesting to me and, I hope, are interesting to the reader. This e-book is more than 1200 pages of my review of interesting casesfrom 2013 through January 2014.

After you purchase please wait for the e-book to upload from PayPal. If it does not upload please e-mail zalma@zalma.com and I willpersonally send you a copy of the e-mail in pdf format.

The Zalma Insurance Claims LibraryThe full Zalma Insurance Claims Library is available at

Insurance Claims: A Comprehensive Guide

Insurance Law

Mold Claims Coverage Guide;

Construction Defects Coverage Guide

Wisdom“If you don’t know where you’re going, you might not get there.” – Yogi Berra

“I rejoice in a belief that intellectual light will spring up in the dark corners of the earth; that freedom ofenquiry will produce liberality of conduct.” — George Washington

“It is a fool’s prerogative to utter truths that no one else will speak.” – Neil Gaiman

“The only proper purpose of a government is to protect man’s rights, which means: to protect him fromphysical violence. A proper government is only a policeman, acting as an agent of man’s self-defense, and, assuch, may only resort to force only against those who start the use of force.” —Ayn Rand

“An unlimited power to tax involves, necessarily, a power to destroy; because there is a limit beyond which noinstitution and no property can bear taxation.” —John Marshall

“There is no such thing on earth as an uninteresting subject; the only thing that can exist is an uninterested person.” – G.K. Chesterton

“The problem with Americans is that we’re fixers, not preventers.” – Gen. Jimmy Doolittle

Zalma's Insurance Fraud Letter -- Page 8 of 17

Barry ZalmaBarry Zalma is the principal of Zalma Insurance Consultants. He is available for consultation on any and all insurance issues faced byyou or your clients.

Barry Zalma founded ZIC to help resolve every insurance claim problem faced by you or your clients. His experience andskill as a consultant and expert witness can make the difference before a jury or other trier of fact. For more than 45 yearsas a claims person and insurance coverage attorney, Barry Zalma has represented insurers, advised insurers on claimshandling, interpreted coverages and testified as an insurance coverage, insurance bad faith, insurance claims handling andinsurance fraud expert on behalf of insurers and policy holders’ suing insurers.

Mr. Zalma has been rated “AV Preeminent” and is an internationally recognized expert on insurance, insurance claimshandling, insurance coverage, insurance fraud, and insurance bad faith. Barry Zalma will promptly review your file materials and advise you about the viability of your decision to sue or your defenses. He can help you narrow the scope ofdiscovery.

Consultation with Mr. Zalma and ZIC can save you or your client thousands of dollars in the defense or prosecution of an insurancedispute. ZIC will assist you in the effort to find a solution to an insurance claims dispute that is fair, intelligent,beneficial and economical.

ZIC is available to provide expert advice and, if needed, expert testimony to individuals and their counsel. Advicefrom ZIC is indispensable to the resolution of insurance disputes. Consultation from ZIC can save you, your counselor client hundreds of hours of investigative and legal work.

With comprehensive knowledge of insurance and insurance claims handling Mr. Zalma understands, and canexplain in language a lay jury understands, how and why insurance claims should be resolved.

ZIC rates are all inclusive. Mr. Zalma’s hourly fee takes account of all incidentals from telephone calls and postage.

Good News From the

* California has suspended 2 key players in one of San Diego County’s largest comp schemes ever.Fermin Iglesias sold durable medical equipment. He also was a lead recruiter for a large fraud ring that lodgedmore than $9.5 million in bogus comp claims. Iglesias advertised in the U.S. and Central America via flyers orcards stuck on windshields. He urged people to contact a call center if they were injured on the job and neededhelp filing claims. Iglesias referred the supposed patients to specific docs in Southern California. Theyprescribed medical tests and treatment — such as chiro, MRIs, pain management, echo cardiograms and evensleep studies. The docs got paid kickbacks for the patients. Chiros such as Steven Rigler had to fill monthlyreferral quotas or their patient pipeline and bribes would be cut off. Ringleaders warned Rigler that he’d fallen$60,000 behind in referrals and would be bounced from the ring unless he paid out $20,000-$30,000. Insurerssuch as The Hartford and Liberty Mutual were billed for the ring’s treatments. Iglesias and Rigler were bootedfrom the state comp system. They also pleaded guilty and await criminal sentencing.

* A tiny rural hospital was a pass-through for more than $90 million of dodgy lab billings imposed on insurers, a Missouri auditsays. State officials were doing a routine audit of Putnam County Memorial Hospital. The audit allegedly found: The hospital receivedmore than $90 million of insurance payments for lab work done at other hospitals around the U.S. And that was just for the 10-month auditperiod. Most billings covered patients the hospital never treated. Instead, the hospital was a shell company for other labs. It submitted billsfor their services and funneled the insurance payments back through the hospital. The outfit also paid salaries of 33 phlebotomists aroundthe U.S. None worked at the hospital. They shipped blood specimens to labs for testing. Prosecutors are reviewing the evidence forpotential criminal actions.

* No go, Indiana’s highest court told Bob Leonard when he appealed his life sentence for abotched home arson that leveled much of an Indianapolis neighborhood and killed 2 neighbors.Leonard and his brother Mark received life without parole as ringleaders of the blazing screw up.Bob appealed to the state Supreme Court. The state’s life-without-parole statute isunconstitutional because it doesn’t require a jury to find aggravating circumstance that outweighmitigators, he contended. The court shot down that argument. Leonard also claimed he wasn’t

Zalma's Insurance Fraud Letter -- Page 9 of 17

aware with a high probability that the explosion would kill someone outside the home, thus undercutting his murder conviction. Leonardlearned more about the potential impact of natural gas explosions with each of 3 attempts to level the home, the court countered. The courtupheld Bob’s long stay in prison this week. Mark’s similar appeal was shot down in May.

* Jacques Roy was a serial conman, on a roll. The Dallas-area doc tried to gouge Medicare for $375-millionof dirty home healthcare claims. “Phony home-health claims have robbed Medicare for years. What’s new wasRoy’s dark genius for amping up patient recruiting and fake claims to unheard-of levels of industrialefficiency,” reads the Coalition’s newest Fraud of the Month. “One more reason Medicare thievery of all kindscould be America’s single largest form of insurance fraud.”

* The feds want to confiscate a fraudster’s $3,363 prison account to repay his victims. Robert Miell isserving 20 years in federal prison. He was the largest landlord in Cedar Rapids, Iowa. He tried to defraudAmerican Family of more than $336,000 in fake storm-damage claims at 145 properties he owned. Miell also

robbed renters of their damage deposits by claiming fake damage repairs using forged invoices. Many inmates like Miell receive moneyfrom family or friends, and some receive wages from prison jobs.

* LaMar Taylor was more risky than the at-risk Medicaid youths he claimed to serve. Taylor owns Global Interventions LLC, aNorthern Virginia firm that provided Medicaid-contracted day treatment services. He billed for hundreds of phantom mentoring sessionswith at-risk youths. He stole nearly $600,000 in Medicaid money in the process. Taylor pleaded guilty and will be federally sentenced Oct.26. He also faces tax charges. Taylor was an all-state Virginia high school basketball player, played for Virginia CommonwealthUniversity, and briefly went pro in Ecuador.

* Chermeca Harris had sickle cell anemia. The condition hurt so badly that the Richmond, Va. womanneeded pain meds. At least that’s what she told her docs. Harris even specified her drug and its delivery:Dilaudid intravenously in her neck. Except that docs tested Harris and found she was free of sickle cell. Harrisalso used the IDs of 2 other people to have Medicaid pay for her drugs. She was scooped up by a nationalhealth-fraud dragnet that charged 441 suspects, including 115 docs. Harris pleaded guilty. She’ll spend up to12 years in federal prison when sentenced for Medicaid fraud and ID theft Oct. 26.

* Farshad Bigdeli never let epilepsy get in the way of a good fraud scheme. The Spotsylvania, Va. manworked at an engineering firm in Northern Virginia. He made a longterm disability claim, citing epilepsy. The insurer agreed to pay 60percent of Bigdeli’s $91,000 salary. Bigdeli then took a $110,000 job in North Dakota. He continued collecting disability even though hisnew salary and job made him ineligible. Bigdeli was questioned about his employment status several times over the years, and repeatedlydenied working a 2nd job. He took in nearly $200,000 in disability money. Bigdeli merely was confused about the disability process, hetestified at trial. He was convicted and prosecutors recommended a 28-month jail term. Bigdeli will be sentenced Sept. 27 in SpotsylvaniaCircuit Court.

* Two con artists were nabbed by the Washington insurance department: Tony Whitt told his insurer that his 2011 Ford F350 truckwas stolen from his driveway. Yet police found the truck in the employee parking lot at a Ford auto dealership in Spokane several monthslater. Whitt had the supposedly stolen F350 appraised for a trade-in there when he bought 2 vehicles. He received 2 years in jail(suspended). Bradley Pierce got into a collision in September 2015. He bought a policy from GEICO the next day. He filed a damage claim2 days after the crash. Pierce lied that a hit-and-run driver banged up his car while it was parked. He also fudged the damage date after thepolicy took effect. Metadata in the photo he took the day of the collision disproved his story, as did a friend’s statement. Pierce received 12days in jail or 20 hours of community service.

* Two former U.S. Postal employees in Dallas took kickbacks so a crooked mental-health counselor could falsely bill a federalworkers-comp program in a $9.5-million plot. Tonya Evans worked as a clerk primarily with the parcel post distribution machine. Shesought disability money, claiming various injuries. Evans was placed on workers comp, receiving more than $340,000 over about 9 years.She finally was approved for disability retirement. McArthur Baker was a mail handler equipment operator. He filed 8 disability claimsover about 17 years. Baker finally stopped working and never returned, yet kept receiving disability. He snared more than $68,000 total. Heretired in 2009 and kept receiving disability benefits. Mental-health counselor Larry Washington paid Evans and Baker each $100 for everyform they filled out falsely saying Washington counseled them. They were part of a larger gang stiffing federal comp programs. Evans andBaker each received 21 months in federal prison. Washington earlier was handed 78 months and must repay $7.7 million.

* Grocery gift cards, cash and free housekeeping enticed Dallas-area seniors to get Medicarehome-health coverage they didn’t need. Viju Mathew and wife Mariamma Viju worked at ParklandMemorial Hospital. They stole lists of more than 3,000 patients. Marketers cold-called perfectlyhealthy seniors to peddle home-health services — normally for infirm, home-bound people. Theservices often involved little more than filling pill boxes. Some patients weren’t seen at all. Most onlywanted home health aides to clean their homes. Three nurses visited another patient’s home. Theystayed only 5 minutes and didn’t do anything. Mathew and Viju each received 30 months in federalprison and must repay Medicare $278,000. Unanswered is what happens to the couple’s kids: Theyhave a 6-year-old daughter, and their eldest son suffers from schizophrenia.

* Carmen C. Debolt’s fraud sentence was more painful than her cancer. The Zanesville, Ohio woman sought reimbursement forcancer-treatment claims for which she said she’d already paid. Debolt received $2,245 in direct insurance deposits to her bank account. TheOhio insurance department investigated, and contacted her doc’s office to verify the treatments. She never received cancer treatment, the

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doc confirmed. Debolt was convicted of 19 insurance-fraud counts, plus other crimes. She received 2 years of probation and must repay theinsurance money.

* Joaquin Rams will serve life without parole for murdering his 15-month-old son for more than $500,000 of life-insurance money.Little Prince died during an unsupervised visit to Rams’ home in Northern Virginia. Prince’s mother objected to the court-ordered visit,fearing for Prince’s life. Joaquin’s shaky finances gave him a murder motive. He was blowing through money with little means of support.He planned to move out of his Northern Virginia home and rent it out to make mortgage payments. His suspicious behavior finally did himin. Rams started planning to move back in. He even wanted fancy new appliances and to re-paint his home, even though his finances wereon quicksand. The Coalition touched off a national debate over how life insurers could allow so much coverage on a baby.

* Vincent Viafore drowned in the frigid Hudson (N.Y.) River when his kayak capsized after his fiancéetampered with it so she’d score $250,000 in life insurance. The river was cold and choppy near West Point.Viafore vanished and drowned when his boat tipped over. Angelika Graswald removed a plug from the boat,and knew that a locking clip that kept the paddle in place was missing. Graswald also acted strangely forsomeone whose fiancée just died. She sang “Hotel California” at a local pub, and posted social-media selfiesshowing her doing a cartwheel. It “felt good knowing he was going to die,” Graswald later told investigators.She also knew she was the beneficiary of 2 life policies worth $250,000 total. Graswald pled to criminallynegligent homicide. She’ll receive up to 4 years in state prison when sentenced Nov. 1.

* Kids were locked in a bedroom fouled with their feces while their home caretaker and parents feasted off Medicaid money. Brianand Melissa Harr had 3 kids — aged 4, 5 and 12. One was severely disabled with intellectual limits and cerebral palsy. The child’scaretaker Deborah Branch kicked back $200 in Medicaid money to the Bristol, Va. couple every 2 weeks. Branch hauled in nearly$208,000 of taxpayer money while doing no caretaking. She vacationed in Myrtle Beach, S.C., for instance, while her timesheets said shewas taking care of the child. The Harrs signed Branch’s timesheets. Investigators found a chamber of horrors: Excrement was everywhere— on the floor, the walls and 2 twin-size mattresses on the floor. There were no lights in the room. The only furniture was the fouledmattresses. The windows were screwed shut, and the bedroom door was locked from the outside. The kids went to school, but were lockedup overnight without bathroom privileges. The Harrs each got 4 years in federal prison, and Branch 6 years. HHS wants more safeguards toprotect Medicare clients like these. The feds opened more than 200 investigations into Medicaid personal-care fraud from 2010 to 2016.

Health Insurance Fraud Convictions

Owner of Home Health Agency Sentenced to 75 Years in Prison for Involvement in $13 Million MedicareFraud Conspiracy

Marie Neba, 53, of Sugarland, Texas, was sentenced on August 11, 2017 by U.S. District Judge MelindaHarmon of the Southern District of Texas to 75 years in prison for her role in a $13 million Medicare fraudscheme.

In November 2016, Neba was convicted after a two-week jury trial of one count of conspiracy to commithealth care fraud, three counts of health care fraud, one count of conspiracy to pay and receive health carekickbacks, one count of payment and receipt of health care kickbacks, one count of conspiracy to laundermonetary instruments and one count of making health care false statements.

According to the evidence presented at trial, from February 2006 through June 2015, Neba and othersconspired to defraud Medicare by submitting over $10 million in false and fraudulent claims for home healthservices to Medicare through Fiango Home Healthcare Inc., owned by Neba and her husband, Ebong Tilong,53, also of Sugarland, Texas. The trial evidence showed that using the money that Medicare paid for suchfraudulent claims, Neba paid illegal kickbacks to patient recruiters for referring Medicare beneficiaries toFiango for home health services. Neba also paid illegal kickbacks to Medicare beneficiaries for allowingFiango to bill Medicare using beneficiaries’ Medicare information for home health services that were notmedically necessary or not provided, the evidence showed. Neba falsified medical records to make it appear as though the Medicarebeneficiaries qualified for and received home health services. Neba also attempted to suborn perjury from a co-defendant in the federalcourthouse, the evidence showed.

According to the evidence presented at trial, from February 2006 to June 2015, Neba received more than $13 million from Medicare forhome health services that were not medically necessary or not provided to Medicare beneficiaries.

To date, four others have pleaded guilty based on their roles in the fraudulent scheme at Fiango. NirmalMazumdar, M.D., the former medical director of Fiango, pleaded guilty to a scheme to commit health carefraud for his role at Fiango. Daisy Carter and Connie Ray Island, two patient recruiters for Fiango, pleadedguilty to conspiracy to commit health care fraud for their roles at Fiango. On August 11, Island was sentencedto 33 months in prison. Mazumdar and Carter are awaiting sentencing. After the first week of trial, Tilongpleaded guilty to one count of conspiracy to commit healthcare fraud, three counts of healthcare fraud, onecount of conspiracy to pay and receive healthcare kickbacks, three counts of payment and receipt of healthcarekickbacks, and one count of conspiracy to launder monetary instruments. Tilong is scheduled to be sentencedon October 13.

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ZIFL wonders what took the government nine years to catch this fraud perpetrator. The sentence, hopefully, will deter others.

$20 Million Medicare Fraud Scheme Defeated

Evelyn Mokwuah, 52, of Pearland, Texas was convicted on August 10, 2017 by a federal jury. Mokwuah, aregistered nurse who was the owner of two home health companies in Houston was convicted for her role in a$20 million Medicare fraud scheme involving fraudulent claims for home health services.

After a four-day trial, Mokwuah was convicted of one count of conspiracy to commit health care fraud and fourcounts of health care fraud for her conduct at Beechwood Home Health (Beechwood) and Criseven HealthManagement Corporation (Criseven). Sentencing has been scheduled for October 6, before U.S. DistrictJudge Gray H. Miller of the Southern District of Texas, who presided over the trial.

According to evidence presented at trial, from 2008 to 2016, Mokwuah and others engaged in a scheme to defraud Medicare ofapproximately $20 million in fraudulent claims for home health services at Beechwood and Criseven that were not provided or notmedically necessary. According to the trial evidence, Mokwuah billed for patients who were not homebound or did not qualify for homehealth services; Mokwuah and others falsified patient records to show patients were homebound when they were not; Mokwuah paidpatient recruiters to recruit Medicare beneficiaries to Beechwood and Criseven; and Mokwuah paid doctors to sign off on falsified plans ofcare for the recruited beneficiaries so that Beechwood and Criseven could bill Medicare for those services.

Co-defendant Amara Oparanozie, 47, of Richmond, Texas, pleaded guilty on May 24, to conspiring with Mokwuah and others to commithealth care fraud a

Nurse-Practitioner Guilty of Distributing Oxycodone and Money Laundering

Ivan Lamont Robinson, a licensed nurse practitioner who was based in Southeast Washington, was foundguilty by a jury August 10, 2017 of 42 federal charges that he distributed oxycodone outside the legitimatescope of professional practice and without a legitimate medical purpose, and two counts of money laundering.

The trial began July 10, 2017, in the U.S. District Court for the District of Columbia, in the courtroom of theHonorable Colleen Kollar-Kotelly. Following the verdict, Robinson, 46, of Washington, D.C., was remandedto the custody of the U.S. Marshals Service. His sentencing hearing will be scheduled at a later date.

According to the government’s evidence, Robinson conducted a pain management practice from 2011 until2013 in the 2000 block of Martin Luther King Jr. Avenue SE. His practice received numerous complaints frompharmacists who suspected that he was operating a “pill mill” rather than a medical pain management practice.“Pill mill” is a shorthand terminology for a medical practice which begins selling prescriptions to customers,

usually for cash.

Through his position as a nurse practitioner, under District of Columbia law, Robinson had authority to prescribe oxycodone to patients.Robinson sold prescriptions to customers in exchange for $370 in blank money orders. Customers came from outside the District ofColumbia to purchase identical prescriptions, 60 tablets of 30 milligrams of oxycodone. Law enforcement executed numerous searchwarrants involving his practice on June 19, 2013. After a meeting with officials of the DEA, Robinson voluntarily relinquished his DEAlicense, which had authorized him to write prescriptions for controlled substances.

During the trial, the government presented testimony from a medical expert who stated that Robinson provided no real medical treatment,and there was no medical basis to prescribe oxycodone. Further, the government’s evidence showed that Robinson deposited over$100,000 in money orders from customers during a four-month period in 2013. With these illegal proceeds, the government showed thatRobinson purchased a brand new Volvo automobile and, during the execution of the search warrants, that he withdrew $108,000. Afterreturning the guilty verdicts, the jury also voted to forfeit Robinson’s $108,000 and the Volvo automobile that he had gained from hisillegal pill mill practice.

Dallas Doctor Sentenced to 420 Months on Health Care Fraud Conviction

Jacques Roy, a 60-year-old doctor was convicted in April 2016 of various health care fraud chargesfollowing a six-week-long trial, was sentenced today by U.S. District Judge Sam A. Lindsay to 420 monthsin federal prison and ordered to pay $268,147,699.15 in restitution, joint and several with all codefendantsto Medicare and Medicaid, announced U.S. Attorney John Parker of the Northern District of Texas.

Roy was convicted of one count of conspiracy to commit health care fraud, eight counts of health carefraud, two counts of making a false statement relating to healthcare matters and one count of obstruction ofjustice. Roy has been in custody since the time of his arrest in February 2012.

The following defendants have also been sentence for their role in the health care fraud scheme:

Wilbert James Vesey, Jr., 210 months in federal prison and $23 million in restitution

Cyprian Akamnonu, 120 months in federal prison and $25 million in restitution

Patricia Akamnonu, 120 months in federal prison and $25 million in restitution

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Charity Eleda, 48 months in federal prison and $397,294.51 in restitution

Teri Sivils, 3 years probation and $885,714.05 in restitution

Cynthia Stiger will be sentenced October 26, 2017.

The government presented evidence at trial that Dr. Roy, Stiger, Veasey and Eleda engaged in a large-scale,sophisticated health care fraud scheme in which they conspired together and with others to defraud Medicareand Medicaid through companies they owned/controlled: Medistat Group Associates, P.A., Apple of YourEye Health Care Services, Inc., Ultimate Care Home Health Services and Charry Home Care Services.

As part of the conspiracy, Stiger, Veasey and Eleda, along with others, improperly recruited individuals withMedicare coverage to sign up for Medicare home health care services. Eleda recruited patients from TheBridge homeless shelter in Dallas, sometimes paying recruiters $50 per beneficiary they found and directed to

her vehicle parked outside the shelter’s gates. Eleda and other nurses would falsify medical documents to make it appear as though thosebeneficiaries qualified for home health care services that were not medically necessary. Eleda and the nurses prepared Plans of Care (POC),also known as 485's, which were not medically necessary, and these POCs were delivered to Dr. Roy’s office and not properly reviewed byany physician.

Dr. Roy instructed his staff to certify these POCs, which indicated to Medicare and Medicaid that a doctor, typically Dr. Roy, had reviewedthe treatment plan and deemed it medically necessary. That certifying doctor, typically Dr. Roy, certified that the patient required homehealth services, which were only permitted to be provided to those individuals who were homebound and required, among other things,skilled nursing. This process was repeated for thousands of POCs, and, in fact, Medistat’s office included a “485 Department,” essentially a“boiler room” to affix fraudulent signatures and certifications.

Once an individual was certified for home health care services, Eleda, nurses who worked for Stiger andVeasey, and other nurses falsified visit notes to make it appear as though skilled nursing services were beingprovided and continued to be necessary. Dr. Roy would also visit the patients, perform unnecessary homevisits, and then order unnecessary medical services for the recruited beneficiaries. Then, at Dr. Roy’sinstruction, Medistat employees would submit fraudulent claims to Medicare for the certification andrecertification of unnecessary home health care services and other unnecessary medical services.

The government presented further evidence at trial that the scope of Dr. Roy’s fraud was massive; Medistatprocessed and approved POCs for 11,000 unique Medicare beneficiaries from more than 500 different homehealth agencies. Dr. Roy entered into formal and informal fraudulent arrangements with Apple, Charry, Ultimate and other home healthagencies to ensure his fraudulent business model worked and that he maintained a steady stream of Medicare beneficiaries.

Regarding Dr. Roy’s conviction for obstruction of justice, the government presented evidence that when the Centers for Medicare andMedicaid Services (CMS) suspended Dr. Roy and Medistat from receiving Medicare payments after June 2, 2011, because of suspectedfraud, Dr. Roy sought an “end-run” around the suspension through the use of another company, Medcare House Calls. Dr. Roy directed themedical providers he employed to be re-credentialed and to bill Medicare under Medcare House Calls, instead of Medistat. Nonetheless,the money that Medicare paid was circumvented back to Medistat and Dr. Roy.

Oncologist Sentenced To Nearly Six Years For Treating Patients With Unapproved Cancer Drugs

D. Anda Norbergs was sentenced to 5 years and 10 months in federal prison for receipt anddelivery of misbranded drugs, smuggling goods into the United States, health care fraud, and mailfraud. As part of her sentence, the Court also entered a money judgment in the amount of$848,671.19, the proceeds of the criminal conduct. A federal jury found Norbergs guilty onNovember 18, 2016.

According to testimony and evidence presented during the nine-day trial, Norbergs, a licensedphysician in Florida, was the head doctor, owner, and operator of East Lake Oncology (“ELO”), acancer treatment clinic located in Palm Harbor. Beginning in at least May 2009, she ordered, anddirected others at ELO to order, drugs from foreign, unlicensed distributors, including Quality

Specialty Products (“QSP”). The drugs sold to ELO by QSP and other foreign, unlicensed distributors were not FDA-approved. In fact,QSP had reportedly sold counterfeit versions of a chemotherapy medication that did not have the key ingredient in the drug. Norbergslearned of this news from other sources yet continued to have QSP drugs administered to patients. When QSP shut down, Norbergsswitched to buying drugs from another foreign, unlicensed distributor. Many of the drugs were shipped directly to ELO from a locationoutside the United States, usually from the United Kingdom. The packaging and documents shipped with the drugs showed that they weremanufactured and packaged for distribution in foreign countries, such as Turkey, India, and Germany.

Unbeknownst to patients, these misbranded drugs were then administered at ELO. After administering these drugs to patients, ELOsubmitted claims for reimbursement to Medicare. In submitting those claims, Norbergs falsely represented that the FDA-approved versionsof the drugs had been administered, when she knew that unapproved and misbranded versions had been given to patients. In so doing,Norbergs intended to generate profits from the difference between the Medicare reimbursement rates for the FDA-approved drugs and thediscounted prices of the misbranded versions of those drugs purchased from foreign distributors.

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Behavioral Health President Pleads Guilty to Medicaid Fraud Conspiracy and Perjury Charges

SHEPHARD LEE SPRUILL, II, 46, of Winterville, North Carolina, pleaded guilty to Conspiracy to Commit Health Care Fraud, andPerjury on August 4, 2017. Under the terms of a plea agreement, SPRUILL faces up to 15 years inprison, $500,000 in fines, and 3 years of supervised release. Under additional terms discussed incourt, SPRUILL also agreed to make restitution in the amount of $1,846,377 to the North CarolinaMedicaid program, as well as additional restitution for any other fraud committed by or throughMedicaid providers Pride in North Carolina, Carolina Support Services, Elite Care, SouthernSupport Services, One to One Youth, Vision of New Hope, Bridge Builders Youth Services, andJameson Consultants.

According to the Criminal Information and evidence discussed in open court, SPRUILL entered into conspiracy with Terry Lamont Spellerand Donnie Lee Phillips, II (both of whom are already imprisoned) to defraud Medicaid in connection with a clinic in Pitt County, knownas “The Medical Office.” SPRUILL, who at that time was the president of a behavioral health practice named Carolina Support Services,had access to lists of patient names and Medicaid Identification Numbers. SPRUILL provided these to Speller and Phillips, who used themto fraudulently bill Medicaid for more than $2 Million in fictitious services. After Medicaid sent payment for the fake services to Speller,SPRUILL received his cut of the proceeds under the guise of loan repayments.

With respect to the charge of Perjury, the evidence showed that SPRUILL testified before a federal grand jury that he had no businessrelationship with Speller, and that he had no knowledge of why Medicaid payments were being split between Speller and SPRUILL. Underthe plea agreement, SPRUILL admitted that he lied about these facts to the grand jury.

Other Insurance Fraud Convictions

Auto Fraud Ring Busted - Leader Gets Ten Years

Michael Charles Young, 30, of Sacramento, the leader of a large auto insurance fraud ring was sentencedrecently to more than 10 years in state prison for bilking insurance companies out of an estimated $500,000 byfiling fraudulent insurance claims.

In one of the larger auto insurance fraud cases in the Sacramento region, detectives are seeking three at-largesuspects with outstanding warrants and asking for the public’s help finding them-Jazlyn Ladana Burrell, 20,of Vallejo; Lavina Louise Nunally, 26, and Desiree Patricia Vasquez, 22, both of Sacramento.

An investigation by detectives with the California Department of Insurance and the California Highway Patrol(CHP) uncovered evidence Young and several co-conspirators filed multiple insurance claims totaling anestimated half a million dollars after crashing cars into each other or filing claims on vehicles with existingdamage-known as paper collisions. The case is being prosecuted by the Sacramento County DistrictAttorney’s Office.

According to detectives, Young’s ring operated in the Sacramento area between 2014 and early 2016 filing dozens of claims rangingbetween $5,000 and $40,000 with a number of insurance companies.

In most cases, false identities were used to register and insure the vehicles used to file claims and accomplices were provided scripts to usewhen communicating with insurers. Some defendants allowed their identities to be used for compensation and then cashed checks issued intheir names. The ring grew as friends and family members were recruited.

Young was arrested in April 2016, and charged with numerous felonies, including insurance fraud, possession of stolen vehicles, identitytheft, and possession of firearms by a convicted felon.

Need to Be Employed to Obtain Workers’ Compensation

Shardette Nyarko, 36, pleaded guilty to a first-degree misdemeanor charge of workers compensation fraud in the Franklin County, Ohio,Court of Common Pleas on Aug. 1. A judge fined her $100 and subsequently suspended her fine, according to the bureau.

The Columbus, Ohio. woman pleaded guilty to workers’ compensation fraud after filing three false claims while unemployed since 2012,telling investigators she needed medical treatment she could not afford.

Investigators reportedly discovered Ms. Nyarko’s fraudulent claims last year while conducting a routine review of disallowed injuryclaims. They found that she filed a false claim in April 2016 and two in 2012, stating in her claims that she was at work at the time of herinjuries. However, investigators determined she was not employed at the time she said she was injured.

Truly Evil Attempt at Insurance Fraud – Life Without Parole

Joaquin Shadow Rams Sr., 45, was convicted earlier this year in the 2012 death of his son Prince and was sentenced August 1, 2017.

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Rams had taken out more than $500,000 in life insurance on Prince in the months before his death. The boy diedduring an unsupervised visit ordered by a Maryland judge over the objections of Prince’s mother, who said she fearedfor her child’s safety. Prince died on just the fourth unsupervised visit Rams had with his son.

Obtaining a conviction in Prince’s death was a challenge for prosecutors, and took several years of legal wrangling.The medical examiner who conducted the autopsy on Prince concluded that he drowned, but later the state’s chiefmedical examiner overruled that finding and changed the cause of death to undetermined.

That opened the door for defense lawyers to argue that Prince died of natural causes, citing a pattern of fever-inducedseizures that had been documented during Prince’s short life. The murder trial became in large part a battle ofmedical experts as to whether febrile seizures could be fatal.

Judge Randy Bellows, who convicted Rams after he waived his right to a jury trial, wrote a meticulous 62-page opinion detailing why thedefense argument that Prince died of natural causes made no sense in light of the specific circumstances of his death.

The judge found that Rams’ decision to take out three separate insurance policies on the boy’s life highly suspicious, noting that “by goingto three different companies he prevented any from knowing about the size of the policies on Prince’s life.” Rams also made a series offalse claims in applications for those policies, like alleging that the boy’s mother was dead in order to avoid telling her about his plans totake out the insurance.

Rams, who maintains his innocence, filed a request seeking to avoid attending Tuesday’s sentencing hearing.But Bellows ordered him to attend, giving Prince’s mother, Hera McLeod, and maternal grandparents theopportunity to give victim-impact statements in Rams’ presence.

McLeod said she can’t help but think of Prince’s death.

Rams was convicted of capital murder, but prosecutors agreed not to pursue a death penalty under an unusualexchange in which the defense waived its right to a jury trial. While Virginia law says a capital-murderconviction requires a sentence of life without parole, Rams’ lawyer, Christopher Leibig, asked the judge tosuspend part of that sentence and provide some option for Rams to be released.

Bellows rejected that request, calling the murder “cold, calculating and callous in its nature, and shattering inits impact.”

Prosecutors also believe Rams is responsible for the deaths of his ex-girlfriend, Shawn Mason, and hismother, Alma Collins. In Mason’s death, prosecutors say Rams believed he would be the beneficiary of a lifeinsurance policy. In Collins’ death, Rams did in fact collect on a life insurance policy.

It is unclear whether Rams will ever face charges in those two deaths. Commonwealth’s Attorney Paul Ebert said the cases remain openand he can pursue charges if needed.

Shawn Mason’s mother, Sheryl Mason, said after Tuesday’s hearing that she is satisfied with the life sentence and is no longer pushing fora separate trial in Shawn Mason’s death.”

Oregon Woman Sentenced for Insurance Fraud

Jennifer Cadwell pleaded guilty to Insurance Fraud in June after an investigation revealed she’d filed a false claimon her Safeco renter’s insurance policy. Cadwell was living in Kootenai County when she reported her home wasburglarized and multiple personal items were stolen. Investigators discovered that she had pawned the personal itemsbefore the alleged burglary and prior to insuring the items with Safeco. Her insurance claim was denied.

On Wednesday, August 2, a judge in Kootenai County, Idaho sentenced her to 30 days in jail and ordered her to pay$1,967 in restitution to, and probation. Kootenai County District Judge Lansing L. Haynes sentenced Cadwell. Thedefendant received a withheld judgment and two years of supervised probation.

ZIFL can only won der why an Idaho judge took insurance fraud so lightly.

Zalma Insurance Consultants Provides the Following Services to its Clients:Acting as a consultant or expert witness on behalf of insurers and insureds in litigation.

Acting as a consultant to the insured in the presentation of a first partyclaim.

Analysis of claims file material to allow the party to present evidence toestablish and document bad faith or the existence of a genuine disputebetween the insurer and insured.

Review of policy wording and claims files to determine if there is a basisfor payment or denial of a claim.

Analysis of insurance litigation for the insurer and the insured.

Consultation with insurance claims personnel on methods to avoid chargesof bad faith.

Consultation with insurers and insureds on insurer compliance with FairClaims Practices laws and regulations.

Training on insurance and insurance law for all insurer

Acting as a mediator to help resolve insurance claims short of litigation.

Analysis of insurance policy wording.

Litigation advice to defense or plaintiffs’ counsel.

Zalma's Insurance Fraud Letter -- Page 15 of 17

Consultation from Zalma Insurance Consultants can save you or your client thousands of dollars inthe defense or prosecution of an insurance dispute. Zalma Insurance Consultants will find a solutionto your insurance claims dispute that is fair, intelligent, beneficial and Economical.

If you only need an opinion letter I will review your entire claim file and policy wording and preparea coverage opinion letter for the flat fee of $4,000.00. Otherwise, my services are billed at $500.00per hour, portal to portal.

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Books from the American Bar Association

The Insurance Fraud DeskbookBarry Zalma, Esq., CFE, 2014 Paperback, 638 Pages, 7x10

The Insurance Fraud Deskbook is a valuable resource, peer reviewed by the American Bar Association, for those who are engaged inthe effort to reduce expensive and pervasive occurrences of insurance fraud. It explains the elements of the crime and the tort toclaims personnel, and it provides information for lawyers who represent insurers so they can adequately advise their clients.Prosecutors and their investigators can use this book to determine what is required to prove the crime and win their case.

The full text of decisions from courts of appeal and supreme courts across the country are provided so the reader can understand whathappens after the investigation is completed and can apply that information to undertake their own thorough investigations. It allowclaims personnel and their lawyers to understand what errors would cause a defect or a not-guilty verdict.

The effort to reduce insurance fraud requires the assistance of both civil and criminal courts. The Insurance Fraud Deskbook can helpthe prudent fraud investigator, insurance adjuster, insurance attorney, insurance Special Investigation Unit and insurance company

management to attain the information needed to deal with state investigators and prosecutor. Available from the American BarAssociation at:

http://shop.americanbar.org/eBus/Default.aspx?TabID=251&productId=214624; or orders@americanbar.org, or 800-285-2221.

Diminution in Value Damages How to Determine the Proper Measure of Damage to Real and Personal Property

This book was written to provide sufficient information to those who became interested in the issue since the GeorgiaSupreme Court decided State Farm Mutual Automobile Insurance Co. v. Mabry, 274 Ga. 498, 556 S.E.2d 114 (Ga.11/28/2001) and includes cases dealing with the use of diminution in value as a method of determining the amount ofloss incurred by a plaintiff seeking indemnity for damage to real or personal property.

Because confusion has reigned across the United States concerning the proper measure of damages for propertydamage to property that has been repaired, Diminution In Value Damages assists the reader in answering the questionsconcerning the proper measure of damage in each of the fifty United States and federal United States jurisdictions

This edition has been totally rewritten and expanded, providing the most extensive and detailed coverage of the issueand a thorough explanation of how to apply diminution in value damages to losses to property.

ISBN: 978-1-63425-295-8, Product Code: 5190524, 2015, 235 pages, 7 x 10, Paperback

Available at http://shop.americanbar.org/eBus/Store/ProductDetails.aspx?productId=203226972

Zalma’s Insurance Fraud Letter© 2017 by Barry Zalma & ClaimSchool, Inc.

4441 Sepulveda Blvd, CULVER CITY CA 90230-4847

http://www.zalma.com # zalma@zalma.com # http://zalma.com/blog

ZIFL is made available by the publisher for educational purposes only as well as to give you general information and a generalunderstanding of the law, not to provide specific legal advice. By using ZIFL you understand that there is no attorney client relationshipbetween you and the publisher. ZIFL should not be used as a substitute for competent legal advice from a licensed professional attorney inyour state.

The LegendMr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award, in 2016.

Zalma's Insurance Fraud Letter -- Page 16 of 17

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant and expert witness specializing ininsurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers andpolicyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in Californiafor more than 44 years as an insurance coverage and claims handling lawyer and more than 49 years in the insurancebusiness.

Check in on Zalma’s Insurance 101 – a Videoblog – that allows your people to learn about insurance in three to fourminute increments at http://www.zalma.com/videoblog.

The American Bar Association, Tort & Insurance Practice Section has published Mr. Zalma’s book “The InsuranceFraud Deskbook” available at http://shop.americanbar.org/eBus/Store/ProductDetails.aspx?productId=214624, or

800-285-2221 which is presently available and “Diminution of Value Damages” available athttp://shop.americanbar.org/eBus/Store/ProductDetails.aspx?productId=203226972

Mr. Zalma’s new e-books Heads I Win, Tails You Lose, The Law of Ethical Insurance Claims, the Insurance Law Handbook, CaliforniaInsurance Rescission Law Handbook, Random Thoughts on Insurance - Vol. IV, and Insurance Fraud & Weapons to Defeat Fraud wererecently added and are available at http://www.zalma.com/zalmabooks.html.

Look to National Underwriter Company for the new Zalma Insurance Claims Library, at www.nationalunderwriter.com/ZalmaLibrary Thenew books are Insurance Law, Mold Claims Coverage Guide, Construction Defects Coverage Guide and Insurance Claims: AComprehensive Guide.

Legal Disclaimer:

The author and publisher disclaim any liability, loss, or risk incurred as aconsequence, directly or indirectly, of the use and application of any ofthe contents of this blog. The information provided is not a substitute forthe advice of a competent insurance, legal, or other professional. TheInformation provided at this site should not be relied on as legal advice.Legal advice cannot be given without full consideration of all relevantinformation relating to an individual situation.

Zalma's Insurance Fraud Letter -- Page 17 of 17