ZIFL – Volume 30, Issue 20
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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 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/
Read the full issue at http://zalma.com/blog/wp-content/uploads/2026/10/ZIFL-10-15-2026.pdf
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