...Dealing with Fraud By: Kevin McCarthy To: Dr. Michelle Rose HSA 515 Health Care Policy, Law, and Ethics December 13, 2012 Abstract As the Chief Nursing Officer, I am responsible for one of the state’s largest Obstetric Health Care Centers. I have received word of some fraudulent behaviors in the center. I will evaluate how the Healthcare Qui Tam affects health care organizations. I will provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. I will devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. I will recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. I will devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations Qui tam is shorthand for a Latin phrase that means “he who sues for the king as well as for himself.” In a qui tam case, the whistle – blower (aka relator) files the suit as a kind of “private attorney general” on behalf of the government. The government can choose to take over the prosecution, but if it declines to do so the relator can proceed alone (Showalter). Any person with information about health care fraud can be a qui tam plaintiff. Person is defined as “any natural person, partnership, corporation, association...
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...Dealing with Fraud Joseph B. Amah Professor Dr. Wanda E. Allen HSA 515 Law and Health Care System Strayer University Delaware County Campus June 18, 2013 Abstract Fraudulent behaviors have deep rooted history in most American organizations, including medical institutions. There is no doubt, therefore, that one of several ways an administrator can succeed as a Chief Nursing Officer (in a facility wrecked by news of abject corruption and empirical fraudulent activities) is being knowledgeable about these historical facts and taking corrective actions. Necessarily, any report of dishonest behaviors such as the one relating to the subject of this paper, will be addressed by a more appropriate applications of provisions of the False Claim Act (as amended in 1986). Due to the inherent risk associated with reporting corrupt corporate behaviors, the FCA regulations entitle whistle blowers to an attractive percentage of funds retrieved as results of qui tam suits. Predicated on these statutory protections, this writer will examine and evaluate the effects of qui tam in the healthcare industry, devise procedures for admissions at medical facilities and subsequently recommend genuine corporate integrity programs with a view of abating or mitigating frauds in these institutions. In conclusion, a plan will be drawn up to protect patients’ information pursuant to applicable federal and state laws. Evaluate how the Healthcare...
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...Dealing with Fraud Vianny Castillo David.Tataw, PhD, MPA, MMIS, FACHE Health Care Policy, Law, and Ethics (HAS 515) September 6, 2013 Introduction Fraud is defined as wrongful or criminal deception intended to result in financial or personal gain. The term is usually associated with financial institutions or perhaps other types of businesses, but it’s not a term that is automatically associated with the health care field. Or at least some of us didn’t think so. However, the sad truth is that health care fraud costs the country an estimated $80 billion a year. It is a rising threat, with national health care spending rising to $2.7 trillion and expenses continuing to outpace inflation. The saddest element of this situation is that recent cases have shown that medical professionals are more willing to risk patient harm in pursuit of successfully executing their schemes. Health Care fraud is in the jurisdiction of the FBI. They are the primary agency responsible for investigating these types of cases, and also for exposing them. They are responsible for the federal and private insurance programs. As the Chief Medical Officer of a large Obstetrics Health Care Center, I am sadden and extremely angry to learn that these types of fraudulent activities are associated with my facility. As I investigate and learn more about the situation, I will also be exploring other topics as listed below. 1. Evaluate how the Healthcare Qui Tam affects health care organizations...
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...introduction of all evidence that would result in modifying written contracts. ANS: F PTS: 1 6. The statute of frauds has to do with fraud in the inducement of a contract. ANS: F PTS: 1 7. Most types of contracts are valid without being written. ANS: T PTS: 1 8. The statute of frauds generally requires that both parties sign the writing. ANS: F PTS: 1 9. A collateral promise is an undertaking to be primarily liable for the principal debtor's debt. ANS: F PTS: 1 10. Jim promises to marry Cynda if Cynda will buy him a new Ferrari for his birthday. This promise must be in writing to be enforceable. ANS: T PTS: 1 11. A part performance exception to the statute of frauds in many states requires both that the transferee has paid at least a portion of the purchase price and has either taken possession of the real estate or has started to make valuable improvements on it. ANS: T PTS: 1 12. A usage of trade is a practice or method of dealing, regularly observed and followed in a place, vocation, or trade. ANS: T PTS: 1 13. In an employment agreement with Karl, Arnold promises to work for Karl for the rest of his life. This promise must be in writing to be enforceable. ANS: F PTS: 1 14. Clara types a letter to David setting forth the terms of a contract between the two of them that falls within the statute of frauds. At the end of the letter, she types her...
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...ACCOUNTING | Case Study 1: And the Fraud Continues | SOLIAT KOSOKO | | Professor: Dr. Timothy Franklin Deleanor Brown | 1/20/2013 | Introduction This case demonstrates organized crime, occupational fraud and abuse. This crime is commonly seen among individuals and organizations that are in a lot of social and financial pressures. Some of the crimes involve organize crime are money laundering, mail and wire fraud, conspiracy and racketeering. Any organization that has weak or no internal control gives employees the opportunities to commit fraud or use company assets without permission. In this case there were multiple internal control weaknesses that allowed Pavlo to carry out the fraud and the different tricks he used to cover the whole scam. In this paper I would be discussing the internal control weaknesses that existed at MCI and contributed to the commission of this fraud, identifying and justifying the approach I would take if I suspected fraudulent activity within an organization, the ethical nature of Pavlo’s actions in this case and the theory related to crime causation to this case. Discuss the internal control weaknesses that existed at MCI that contributed to the commission of this fraud. Internal Controls is an integral part of any organization's financial and business policies and procedures. Internal controls consists of all the measures taken by the organization for the purpose of protecting its resources against waste, fraud, and inefficiency; ensuring accuracy...
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...they were he was able to roll out the red carpet of capital promises and people came running to be included at the party. Mr. Madoff was certainly an equal opportunity crook, he took advantage of everyone, and the only prerequisite was to have money. Influential people from all walks of life found themselves mesmerized by “Uncle Bernie” and invested millions of dollars, failing to remember the old adage, “if it walks like a duck, if it quacks like a duck, then it’s probably a duck!” Describe three types of illegal business behavior alleged against Mr. Madoff and for each type of behavior, explain how the behavior is illegal or unethical in the conduct of business. The first unethical and illegal behavior of Mr. Madoff is securities fraud....
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...Donald R Cressey hypothesis became known as the “fraud triangle.” He studied the reasons behind the fraud. What led them to commit the fraud. His fraud triangle can explain of occupational offenders but not all. According to Cressey: “The first point represents a perceived non-sharable financial need which fell into six basic categories: violation of ascribed obligations, problems resulting from personal failure, business reversals, physical isolation, status gaining, and employer – employee relations.” The second element of the fraud triangle is: The perceived opportunity. Cressey’s view is there are two components to the perceived opportunity: general information and the technical skill. The final point stands for rationalization. This is where the fraudster justifies the stealing. Cressey placed these individuals into three categories: independent businessmen, long-term violators, and absconders. His research was published in Other People’s Money: A study in the Social Psychology of Embezzlement. Cressey’s final hypothesis was: Trusted persons become trust violators when they conceive of themselves as having a financial problem which is non-shareable, are aware this problem can be secretly resolved by violation of the position of financial trust, and are able to apply to their own conduct in that situation verbalizations which enable them to adjust their conceptions of themselves as trusted persons with their conceptions of themselves as users of the entrusted funds...
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...identifying, reporting, and dealing with credit card fraud. Frieze is able to provide a free service to users through charging credit card companies for the cost savings that come with reducing the size of their customer service department that responds to fraud. Problem: After being notified of fraud, dealing with credit card companies to verify your information and freeze your card can be incredibly difficult. In addition, many individuals do not have cellular connections while traveling abroad and thus have to wait until their return to freeze their cards. This leads to further fraudulent charges. Lastly, some credit card companies are better than others when it comes to detecting fraud but this is a costly enterprise. Frieze allows consumers to safe time and credit card companies to save money. Product/Services: To clarify, this service is a mobile application that will exist on both Apple and Android platforms. After the user completes a thorough certification process, they will have the ability to avoid calling the credit card provider and freeze their account with the click of a button. In addition, Frieze creates a platform of simplified notifications by letting the user know every time their card was used 50 or more miles from their current location. The user will need to enter a 4-digit passcode to enter the application as well as written text before freezing a card or account. Target Market: The highest credit card fraud reporting was from the age range...
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...their long-term employees. This shows that not only do people like the company that they are working for, but that the company also respects the employees. The owner and accountant also show that they have a lot of trust in the employees with the current petty cash scenario. The accountant is also taking the right steps toward maintaining some internal controls by using pre-numbered invoices. The use of the pre-numbered invoices makes it easier to record the invoices and also maintains some order to the system that he is trying to establish. He has expressed interest in purchasing an indelible ink machine to print the checks. The use of indelible ink to print the company’s checks would be a great step towards combating any type of fraud that may happen. The purchase of an indelible ink machine is advised, especially with the company planning to go forward with becoming a public company. Changes to Be Made Before going into the detailed requirements of meeting the guidelines to become a public company, there are some obvious changes that should be made. Since there has been an issue in the...
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...Chaos in the Caribbean Strayer University Forensic Accounting and Fraud Examination ACC 571 Dr. Timothy Brown ------------------------------------------------- 1. Evaluate Avey’s role as an expert witness for the Jamaican government. Avey and his firm were hired by the Jamaican government starting in the early in the 90s to investigate accusations of fraud and mismanagement and prepare reports outlining his findings starting with the Blaise Merchant Bank and Trust Co which spread to two similar but larger cases involving Century National Bank and its related financial entities and Eagle Merchant Bank. As an expert witness, Avey was hired by the Jamaican government to provide forensic investigation and audit support. He utilized specialized investigative skills in carrying out an inquiry conducted in such a manner that the outcome would be applicable to a court of law. In addition he examined evidence regarding assertions to determine its correspondence to established criteria carried out in a manner suitable to the court. Avey conducted his investigation grounded in sound forensic accounting principles where he quickly discovered self dealing in the Blaise Case where money was lent from one Blaise financial entity to companies controlled by its principal shareholders. In the Century Case, dishonesty was the main cause of the problems where the use of depositors’ funds to acquire such assets as real estate (which had also been the case with Blaise) for the...
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...INSIDER DEALINGS AND THE PROBLEMS OF BUSINESS ETHICS IN THE BANKING INDUSTRY IN NIGERIA. BY Adegboye Folasade Bosede Department of Banking & Finance Covenant University Ota, Ogun state. Tel: 07032678252 e-mail:sadeadegboye@yahoo.com THIS PAPER IS TO BE PRESENTED AT: THE 8TH ANNUAL CONFERENCE OF THE NIGERIAN SOCIOLOGICAL SOCIETY AT TEMPRANCE HOTEL OFF THE BELLS UNIVERSITY ROAD OTA, OGUN STATE. DATE: TUESDAY NOVEMBER 25- THURSDAY NOVEMBER 27, 2008 ABSTRACT Professionalism in banking is violated when ethical or legal fundamentals are breached or blatantly disregarded. Ethics is a strong code of morality, which for an occupation such as banking, plays an important role in the well being of individuals, businesses, national and international economies. Unethical conduct manifests itself in various ways, including insider abuse, fraudulent dealings; irregularity/inaccuracy in rendition of reports, these are problems bordering on business ethics as evident in the Nigerian banking crisis. A multiple regression analysis was used and from the summary of the finding, we can infer that the consequences of insider dealing and problem of business ethics can be disastrous and could result in loss of confidence and trust in the industry, loss of business for the institutions, shareholders, board/management disputes, operational losses, distress of the sector, and liquidation of institutions, capital flight, and stagnation of the economy. INTRODUCTION Traditionally, the role of...
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...Jane Shoes Apollo Shoes 1234 Shoe Avenue Shoetown MA 12345 Dear Ms. Jane, This letter serves to confirm the request for Team C CPA to consult with Apollo Shoes on Sarbanes-Oxley Section 404. The consultation will include the significant regulations and guidelines related to audits of internal control. We will identify the internal control risks within Apollo Shoes as well as a description of the relationship between internal controls and the audit process, and a brief synopsis of our responsibility in detecting and reporting fraud. Guidelines According to COSO “Internal control is broadly defined as a process, effected by an entity’s board of directors, management, and other personnel, designed to provide reasonable assurance regarding the achievement of objectives.” “While internal control is a process, its effectiveness is a state or condition of the process at one or more points in time.” The Sarbanes-Oxley Section 404 Act, requires management to produce an “internal control report” along with the annual Exchange Act report. This report is required to confirm “the responsibility of management for establishing and maintaining an adequate internal control structure and procedures for financial reporting.” The report must also “contain an assessment, as of the end of the most recent fiscal year of the Company, of the effectiveness of the internal control structure and procedures of the issuer for financial reporting.” To successfully complete this management...
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...Today, the audit profession minimizes its role in fraud detection, and expresses that is the responsibility of management. By denying responsibility for fraud detection, auditors intend to guard themselves against legal claims. For several decades the profession inched away from fraud detection and became more engrossed in reporting issues, attempting to lay the responsibility for fraud on management. Generally, the accounting profession has been very reluctant to go back to their old ways and accept they have any specific responsibility for fraud Then, SAS 82 entitled Consideration of Fraud in a Financial Statement Audit was implemented in 1997 to assist auditors in detecting financial statement fraud in practice. SAS 82 also provided more explicit guidance on how auditors could achieve fraud detecting by looking at high-risk areas and categories. SAS 82 was superseded in 2002 by SAS 99 entitled Consideration of Fraud in a Financial Statement Audit to expand procedures to detect fraud. Association of Certified Fraud Examiners (ACFE) The report found that employees pose the greatest fraud threat in the current economy. Therefore, a culture of openness, honesty and a positive work environment and providing assistance to employees dealing with personal pressures is essential in organizations. 77% of all of the frauds included in ACFE’s study were committed by people working in operations, sales, customer service, purchasing which is consistent with previous ACFE studies. ...
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...Forensic accountants are the auditors of the forensic accounting practice. They investigate, coordinate data and offer their evidence in trial; and because it is forensic business, the evidence they find is suitable to present and will hold its proof in a court trail. Forensic accountants usually engage in different sectors of the business world; economics, finance, accounting, business management and marketing, to name a few. They utilize their understanding of these different sectors to gather and investigate data that will be used in litigation. Currently though, we live in a world in which financial fraud is becoming increasingly more prevalent. Forensic accountants are expanding their roles and venturing into financial fraud prevention. Forensic accountants are utilizing their skills and designing policies to reduce the risk of fraud, and working closely fraud deterrence research. To be a forensic accountant, the individual needs to possess certain skills and abilities to effectively perform the tasks at hand. A forensic accountant needs to have excellent communication skills, both in oral and the written language. Communication is the effective way to convey thoughts, messages and information. It requires the individual to actively convey the message to the receiving party. The communication is complete when the receiving party has understood the message. In their search for evidence, among data that may be or may not be written, forensic accountants need...
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...can make decision whether to invest or not. However, the case of fraud and manipulation in a company are still critical and need to be monitored by certain functional department as such to be the whistle blower for any irregularities that may arise in the company. In fact, over the last decade, there were various regulatory agencies and interest groups in existence which had been aggressively promoting the idea of an effective audit committee in all public listed companies. Yet, the absence of audit committee in a private company might be the cause for unstoppable practices of fraud. Therefore, the objective of this study is to determine whether the new theory of this formation of audit committee in a private company, can really help to eliminate or at least minimize the fraud. To achieve this goal, the study will conduct a survey based on questionnaires that will be distributed to the top management of a private companies, charted accountant i.e auditors and lecturers of audit course. The findings will be used to support the theory of this research. In the article, Albrecht (2008) declared, “the pressure may be the need to make earnings look better to meet debt covenants” (p. 22). It was true because the profit indicates the performance of a company and so creative accounting might be used to engineer the financial statement to have the so called profitable company. Basically, there are two types of fraud which...
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