Friday, September 18, 2015

Insurance Commissioner prevails in conviction appeal

Andre Zamora

A man convicted of insurance fraud lost a recent appeal to overturn the conviction.

Andre Zamora-Sarmiento (Zamora) was convicted of one count of felony insurance fraud in July 2014 after attempting to bilk an insurance company of more than $13,000 by altering medical bills that he submitted for reimbursement. Read our news release about his conviction.

In November 2011, Zamora was involved in a car collision in Tacoma. After the collision, Zamora sought medical attention at a Renton hospital emergency room and later sought a second opinion from a Bellevue hospital. Zamora then submitted falsified medical bills to USAA insurance company for reimbursement. He submitted three false claims to USAA totaling more than $14,857; the actual amount of the three claims totaled $1,621.

The insurance company paid Zamora's first two claims, netting him $4,200 more than the actual cost of the bills. He submitted a third claim that was inflated by $9,000. The company sought documentation, which Zamora refused to provide. He also refused to provide authorization for the company to contact the hospital directly for a copy of the bill. The insurance company declined the bill and referred the case to the Insurance Commissioner’s Special Investigations Unit.

The appeal hinged on a legal technicality about the number of offenses versus the number of charges. In this case, attorneys used multiple examples of falsified bills Zamora submitted to prove one act of insurance fraud. There’s also an argument about the technicality of the instructions the prosecutor gave the jury. The appellate court found the state prosecutor did not err and upheld the conviction.

Zamora was sentenced in July 2014 two months in jail with work release and credit for 14 days served, and to pay restitution of more than $7,100.