Zalma's Insurance Fraud Letter - September 15, 2021

A Video from ZIFL - 9/15/2021 - New Articles on Insurance Fraud

Cease And Desist Orders Issued to Four Companies Allegedly

Selling Home Warranties Without a License The California Department of Insurance announced September 7, 2021 that it has issued Cease and Desist Orders, effective
immediately, to four companies who allegedly engaged in selling home warranty contracts in California without proper authorization.
Under the Orders, the companies must immediately stop selling the contracts. To protect consumers from fraud, any company marketing and selling home warranty contracts to California consumers must be licensed by the Department of Insurance.

“California consumers place their trust in home warranty companies to provide coverage when something breaks,” said Insurance Commissioner Ricardo Lara. “Our licensing process is intended to protect consumers and ensure ethical standards and practices. Our
team works diligently to help companies understand and meet these standards, and when they do not, we take decisive action.” The Cease and Desist Orders were issued to:
• Complete Care Home Warranty, LLC
• Global Home Protection, LLC
• Fundamental America, LLC, doing business as Priority Home Warranty
• First Premier Home Warranty

The Department launched an investigation after receiving a complaint from a consumer alleging that these unlicensed home warranty companies were marketing and selling their plans in California. During the investigation, Department investigators, using aliases, visited each of the companies’ websites and obtained multiple coverage quotes for California addresses. After initially receiving the quotes by emails, the companies then sent multiple follow-up emails to the investigators in attempts to sell the warranty contracts. Consumers are advised to check the license status of a company before purchasing a policy and contact the Department at 800-927-
4357 if they suspect they may be a victim of fraud.

Insurance Fraud Indictment Thrown Out Because of Inadequate Presentation to Grand

Jury Prosecutor Improperly Relied on Insurer’s Fraud Investigator’s Inadequate Investigation to Indict Physician and Assistant

New Jersey State insurance law requires insurers to maintain a Special Investigative Unit (SIU) to investigate and report insurance fraud to the state. After the report is made the state must conduct its own investigation to determine if a prosecutable fraud occurred. In State Of New Jersey v. Yvonne Jeannotte-Rodriguez, Marta I. Gal Van, Lisa Ferraro, Nos. A-4361-19, A-4371-19, A-4374-19,  Superior Court of New Jersey, Appellate Division (August 25, 2021) The New Jersey Appellate Division was faced with three appeals, after the State contended the trial court wrongly dismissed (without prejudice) a six-count indictment against Lisa Ferraro, M.D., Yvonne Jeannotte-Rodriguez, and Marta Galvan. During the relevant time period, Rodriguez served as a medical assistant in Dr. Ferraro’s medical office, and Galvan was the office manager and worked on billing.

THE INDICTMENT

The State alleged Rodriguez practiced medicine without a license; Dr. Ferraro and Rodriguez fraudulently billed for Rodriguez’s services; and Galvan joined Rodriguez and Dr. Ferraro in conspiring to commit this fraud. The State asserts it presented sufficient
evidence to survive dismissal and urges us to reinstate The indictment is the second attempt to indict the doctor and her assistant. The trial court dismissed the indictment without prejudice, holding it was “palpably deficient in its failure to produce any testimony before the grand jury to support the dates set forth in the indictment.

You can read the total issue and the full articles https://zalma.com/zalmas-insurance-fraud-letter-2/

ClaimSchool, Inc. – Insurance Education
Good News From the Coalition Against Insurance Fraud
Insurance Fraud Results in Murder
Health Insurance Fraud Convictions
Other Insurance Fraud Convictions
Free Insurance Videos
Zalma on Insurance Claims Part 105 Third Edition

The full text of the September 15, 2021 issue of Zalma's Insurance Fraud Letter is now available with the September 1 issue of ZIFL and you can read last two issues of ZIFL here.

© 2021 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders.

He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business.

He is available at http://www.zalma.com and zalma@zalma.com. Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award. Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;  Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/  The last two issues of ZIFL are available at https://zalma.com/zalmas-insurance-fraud-letter-2/  podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4