ZIFL – Volume Number 29 Issue No. 8
April 15, 2025
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The Source for the Insurance Fraud Professional
Post 5049
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Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th 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/ You can read the full issue of the April 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
This issue contains the following articles about insurance fraud:
California Department of Insurance Guidance to Insurers for Proper Handling of Wildfire Claims
The Department expects insurers handling smoke damage claims to comply with California Insurance Code provisions that govern claims settlement practices, including without limitation California Insurance Code section 790.03(h), and all other applicable laws and regulations. In particular, insurers must adopt and implement reasonable standards for processing smoke damage claims. Also, an insurer must make good faith efforts to effectuate prompt, fair, and equitable settlements of smoke damage claims where liability is reasonably clear. Further, section 2695.7(d) of the Fair Claims Settlement Practices Regulations requires every insurer to conduct and diligently pursue a thorough, fair, and objective investigation of a claim.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
Challenge to Guilty Plea Fails
Post Conviction Review Results in Affirmation of Sentence
Lewis R. Brown, appealed from the December 20, 2023 order entered in the Delaware County, Pennsylvania Court of Common Pleas denying his petition filed pursuant to the Post Conviction Relief Act (“PCRA”), 42 Pa.C.S. §§ 9541-46, as meritless.
In Commonwealth Of Pennsylvania v. Lewis R. Brown, No. 197 EDA 2024, No. J-S02022-25, Superior Court of Pennsylvania (March 24, 2025) reviewed his appeal after his request for post sentence motion to reconsider his sentence was denied.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
Not All Claims of Insurance Fraud Are Viable
Lawyers and Claims Investigators Must be Able to Recognize the Difference Between Fraud and Insanity
When I was a law student I was required to serve a legal aid office in the poverty stricken (at that time) neighborhood of Venice, California. I met a lot of nice people who just needed a little help with a landlord or lender. Some were really interesting and I met Jesus who claim to have just returned, a man who claimed to have invented the Norton Bomb Site that was used throughout World War II by the US Army Air Force, and other people who had serious problems. I thought the interesting people were just the cause of the beach city and tourist attraction of Venice and Muscle Beach. I was wrong.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
Heath Insurance Fraud Convictions
Owner Of Florida Health Care Companies Sentenced for Employment Tax Crimes
Defendant Did Not Pay Over $10M in Taxes
Paul Walczak controlled a network of interconnected health care companies operating under various names, including Palm Health Partners. Through another of his entities, Palm Health Partners Employment Services (PHPES), Walczak employed over 600 people and paid over $24 million annually in payroll. As such, Walczak was required to withhold Social Security, Medicare, and federal income taxes from his employees’ paychecks and to pay those monies over to the IRS each quarter, and to pay the companies’ portion of Social Security and Medicare taxes.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-fourth 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.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
Millions Collected from Universal Property & Casualty Insurance Company for Catastrophe Fund
April 1, 2025 Press Release From Florida A.G.
Attorney General James Uthmeier secured the return of tens of millions of dollars from Universal Property & Casualty Insurance Company (UPCIC) to the Florida Hurricane Catastrophe Fund (FHCF). The agreement resolves allegations that the company fraudulently submitted numerous ineligible claims for reimbursement in violation of the Florida False Claims Act. This is the first time the Office of the Attorney General has secured repayment related to an insurance fraud case.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
California Restaurant Owner Sentenced for $1,773,245 COVID-19 and Tax Fraud Schemes
Leronce Suel was the majority owner of Rockstar Dough LLC and Chicken Feed LLC, both of which operated restaurants in the San Diego area, including Streetcar Merchants in the North Park neighborhood. He conspired with others to underreport over $1.7 million in gross receipts on Rockstar Dough’s 2020 corporate tax return and COVID-19 relief applications. Suel’s businesses fraudulently received $1,773,245 in COVID-related Paycheck Protection Program loans and Restaurant Revitalization Fund grants; two programs created to provide financial assistance to American suffering economic harm as a result of the COVID-19 pandemic. Suel was sentenced April 11, 2025 to 42 months in prison for schemes to defraud COVID-19 relief programs and filing false tax returns.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
Soft Fraud
When someone deliberately fakes an accident, injury, theft, or intentionally commits arson or other loss to collect money without right from insurance companies, it is considered a hard fraud. Insurance criminals often act alone. Increasingly, organized crime rings stage large schemes that steal millions of dollars. When a legitimate loss occurs and an insured adds a single television, an I-Pod, a tablet or a cellular phone to the loss to cover the deductible, it is considered a soft fraud.
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455, zalma@zalma.com, https://zalma.com, https://zalma.com/blog