Organizational Responsibility and Current Health Care Issues Paper - Health Care Fraud Roberta Roelofs HCS / 545 November 17‚ 2014 Michael Grossman Health care fraud is a current health care issue throughout the health care industry from hospitals to home care services. “The National Health Care Anti-Fraud Association (NHCAA) estimates that health care fraud accounts for at least three‚ but as much as ten percent of total health care expenditures”(Hubbell‚ 2006). Health care organizations
Premium Health care Fraud Medicine
When does employee fraud occur? It is commonly accepted that the presence of the three elements of the “Fraud Triangle” increases the risk of employee fraud: Motivation: The employee is somehow motivated to commit a fraud. Economic factors such as personal financial distress‚ substance abuse‚ gambling‚ overspending‚ or other similar addictive behaviors may provide motivation. The current national economic recession may serve to increase the incidence of such financial motivations. Opportunity:
Premium Fraud Ponzi scheme Credit card
Health Care Management Cluster 14 November 2011 Research Paper U.S. Health Care and Compliance A System Challenged By Schemes‚ Scams‚ Fraud‚ and Abuse “Laws are made to restrain and punish the wicked; the wise and good do not need them as a guide‚ but only as a shield against rapine and oppression; they can live civilly and orderly‚ though there were no law in the world.” John Milton (1608-1674) On August 31‚ 2010‚ in Los Angeles‚ California‚ the former chief
Premium Health care Healthcare Health economics
The latest Report to the Nations On Occupational Fraud and Abuse‚ the biennial study of global fraud by the Association of Certified Fraud Examiners‚ finds that organizations lose an average of 5 percent of revenues to fraud each year‚ with a median loss of $140‚000. However‚ just over one-fifth of fraud schemes results in losses topping $1 million. Perhaps even more disturbing was the median length of time before the frauds were detected: 18 months. And‚ that’s not all; the study found that almost
Premium Fraud Internal control
ENRON CORPORATE FRAUD (2001) Submitted by: AMIT SHARMA PGDM (016)/09-11 What is FRAUD? In the broadest sense‚ a fraud is an intentional deception made for personal gain or to damage another individual. The specific legal definition varies by legal jurisdiction. Fraud is a crime‚ and is also a civil law violation. Many hoaxes are fraudulent‚ although those not made for personal gain are not technically frauds. Defrauding people of money is presumably the most common type of fraud‚ but there have
Premium Enron
the prevention and detection of fraud rests with both those charged with governance of the entity and with management. ISA/HKSA 240 (Clarified) also provides expanded operational guidance for auditors to consider the existence of material misstatement due to fraud in a financial statement audit. It emphasizes the auditor’s increased responsibility for detecting fraud‚ and the auditor is now required to be more proactive in searching for fraud during the whole audit process
Premium Auditing Audit Financial audit
Healthcare fraud is a major issue in our Healthcare system. It affects our overall economy and well-being of our citizens. There are many different types of healthcare frauds such as insurance fraud‚ drug fraud and billing fraud. Insurance fraud occurs when the insurance provider is given false insurance claims with the intent to defraud. As a result of frequent false insurance claims‚ the inspection procedure uses the best available experts and verification process to check the false claims
Premium Health care Fraud Medicine
Uncovering Fraudulent Workers Compensation Claims One of the most common and popular fraud types is Workmans Compensation Fraud. This also happens to be the type of fraud that any employer is in the position to help and assist with uncovering the truth. Fraud is actually committed when an employee deliberately lies so that he or she will receive benefits. This usually happens when an employee claims a work-related injury when in fact‚ it isn’t. Another case is when he or she exaggerates a minor
Premium Fraud Internal control Crime
ACC460 –Auditing Video Case Fraud and Tone at the Top - Video Case Questions This video is an informative video made for accounting students and employees that outlines the danger of corruption and fraud in the workplace. The majority of the video is an interview with Walt Pavlo of MCI Worldcom. He explains his case and the steps that lead him to take the actions that landed him in prison. While he is telling his story two gentalmen describe how Walt’s story relates to the world of auditing
Premium Employment Ethics Internal control
Case 1.9 ZZZZ Best Company‚ Inc. Delta. Describe the elements of the Fraud Triangle that apply to this case. Assume you are the perpetrator. Is there a better way to perpetrate this fraud? If there is‚ describe your method. Specify practical recommendations for the client to prevent this fraud from occurring in the future. The first element of the Fraud Triangle in the case of ZZZZ Best‚ case 1.9 is Incentives/Pressure. Incentives/Pressure- As a result of the pressure placed on a person who
Premium Fraud Barry Minkow Credit card fraud