“Arson for Profit: How an Attempt to use Arson & Fraud to Fund Terrorism Failed” This story is based on a real case involving a member of Russian/Armenian organized crime, real insurers, investigators, lawyers, fire fighters, and insurance brokers. The names, descriptions, and identities of the people involved have been changed to protect both the guilty and the innocent. The report to the US Senate, after this case was decided by the California Courts, reveal…

FRAUD CHECKLIST Response to fraud checklist. The following video was adapted from my book, “Insurance Claims A Comprehensive Guide” Published by the National Underwriter Company and is available at the Zalma Insurance Claims Library…

 SUMMARY-3 Malcolm Sparrow of Harvard’s Kennedy School of Management cited the dead as a glaring example of how much more needs to be done “to properly excise the cancer of fraud” from healthcare. The healthcare industry does “a terrible job of crime control,” Sparrow told a Senate panel, with almost no procedures to routinely verify that medical claims presented were true, or that services provided were medically necessary. The following video was adapted from my…

SUMMARY-2 Reporting on the inadequacy of governmental oversight of Medicare and Medicaid, a U.S. Senate committee reported last year that Medicare had paid as much as $92 million from 2000 to 2007 for medical services or equipment ordered or prescribed by doctors who were dead at the time. Many had died more than five years before the date when they supposedly ordered or authorized the service. The following video was adapted from my book, “Insurance…

SUMMARY What has been the result of these battles against fraud? Has the number of prosecutions for insurance fraud increased? Not to any appreciable degree. The prosecution of insurance fraud is still rare. State statutes compelling insurers to form fraud investigation units usually have no penalties if the insurer fails to establish such a unit (compared with California regulations that impose a $55,000 fine for failure to establish a SIU or loss of the certificate…

The Bubenik Case In Medical Protective Co. v. Bubenik, No. 09-2324 (8th Cir. 02/18/2010) the Eighth Circuit Court of Appeal was faced with this question and resolved it against the person asserting the privilege and in favor of his insurer who claimed that Bubenik failed to cooperate in his defense by asserting the privilege. Medical Protective Company (MPC) brought a declaratory judgment action against its insured, Dr. James Bubenik, and Joseph and Mary Johnston, who…

The Fifth Amendment is No Use to a Plaintiff he Fifth Amendment to the U.S. Constitution protects an individual from being forced to testify in a manner that might incriminate him or her and subject the witness to prosecution. It is a defense, however, not a weapon that can be used against a defendant in a civil suit. Since civil litigation is entered into voluntarily, testimony in a civil suit brought by a plaintiff is…