...Frauds and Schemes Introduction This paper is about the lies and deceits of people, and how they take advantage of everyone around them. We will be looking at two major insurance frauds and a major ponzi scheme between a father, son, and a small town in rural Utah. All of the people involved in these insurance frauds and ponzi schemes represent poor business ethics. Frauds and Schemes At the beginning of the economy going under some people weren’t sure where to turn to when their houses started to go into foreclosure, or they were so far in dept that they didn’t know what to do. A large number of those people got an idea that they could “accidently” start their house on fire, or make it look like a fault of some sort that they could collect their insurance money and life would go back to normal. Well they were wrong that just landed them a hefty fine and quite a few years in federal prison. A great example of this is an incident that happened to a man by the name of Marc Thompson. He was a high living executive of a Chicago grain company that went under and put him deeply into debt. In desperation, he torched his home for the $730,000 in insurance money. To make it appear like a suicide, he led his 90-year-old mother Carmen downstairs, doused the basement with accelerant and tossed the match. Marc Thompson was sentenced to 190 years in federal prison. (Quiggle) People all over the U.S. want to have health insurance that will cover their doctor’s visits and hospitalizations...
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...In addition to the benefits associated with monetary or financial rewards with by faking an illness online, the prospect of insurance or disability fraud could also explain why some individuals are more likely to exaggerate or fake symptoms of chronic illness and permanent disability than others. For instance, some of the more conservative estimates regarding disability benefit fraud suggest that “approximately $60 billion in annual Medicare payments are fraudulent. In short contrast, current efforts to prevent, detect, and prosecute healthcare fraud have produced only modest returns, recovering only $4.1 billion in 2011” (Gray et al., 2013, p. 749). Offenders looking to commit medical fraud, for example, might decide to feign symptoms of illness...
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...Insurance Presentation Report Report on: The Development of the Brazilian Insurance Industry Submitted to: Dr. Bogusław Bamber Presentation date: BBA Finance & Accounting Semester 5, Academic year 2013-2014 Jamir Issa de Oliveira 25139 ......................... Vinicius Appolinario 25545 ......................... Executive summary The aim of this report is try to evaluate how the insurance industry has developed in Brazil since it began its operation in 1808, operating in the begging only with maritime insurance through company named Boa Fé. During that time Brazil was still a colony of Portugal and Boa Fé Company had the role to insure ships transporting valuable goods such as gold and precious woods extracted from Brazil and sent to Portugal. In 1850 was when the Brazilian insurance industry started to develop due to creation of law specifically to the Brazilian Insurance industry. These new law and regulations made possible the raising of new company in the market which operated not merely in the maritime sector but also in other kind of insurance such as property insurance for example. The attractiveness of the Brazilian market took attention of multinational corporations. The first foreign insurance companies arriving in the Brazilian market was in1862 and in the following years many other foreigner companies kept come to Brazil and from 1950 to 1990 the Brazilian insurance industry got slower its pace...
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...Health Insurance Fraud By: WAHEED ALKHAMEES KHALED ALNAFEE Further Issues Hospital Administration PA 551 Master of Health and Hospital Administration (Parallel) King Saud University One:- Introduction Definition Insurance is the equitable transfer of the risk of a loss, from one entity to another in exchange for payment. It is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. An insurer, or insurance carrier, is a company selling the insurance; the insured, or policyholder, is the person or entity buying the insurance policy. The amount of money to be charged for a certain amount of insurance coverage is called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice. The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a financial (personal) loss. The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insured will be financially compensated. Types of Insurance Services Insurance can take a number of different forms. Some of these types: Auto insurance Auto insurance protects the policyholder against financial loss in the event of an incident involving a vehicle they own, such as...
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...benefits, or to make a budgetary benefit. Both people and social insurance suppliers confer medicinal services extortion, in various diverse ways. The laws in regards to social insurance misrepresentation differ by purview, however both state and government laws are set up to diminish and rebuff this wrongdoing. Fraud in medicinal services can expect differing frames. As indicated by the National Health Care Anti-Fraud Association, the most widely recognized is charging for medicinal services benefits that were never rendered, either by adding charges to honest claims, or by utilizing genuine patient names and medical coverage data to create claims. Up coding is the second most normal; third is the ponder arrangement of medicinally superfluous administrations, which incorporate tests, surgeries, and different methods....
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...themselves or others in some way. Such misbehaviour infringes accepted societal norms. 2. Define compulsive consumer behaviour. Ans: it is the compulsion of buying which has serious consequences. 3. What is a consumer boycott and why would a consumer resort to this? Ans: rejection of a brand or company and the encouragement of the others to so not deal is known as consumer boycott. A consumer would resort to such kind of behaviour when he or she is not satisfied with the product and hence discourages other to buy it. 4. What is consumer misbehaviour related to products and services? Ans: Shop Lifting costs billions of pounds to retailers every year and consumers not only steal products but also engage in insurance fraud, hotel thefts and phone service fraud which also costs millions of pounds every year. 5. What is consumer misbehaviour related to price? Ans: If a consumer has standard rail ticket yet occupies a seat ina first class compartment. This is misused of a service but it is also an example of use without paying which in many guises is misbehaving over price. 6. What is consumer misbehaviour related to distribution? Ans: Boot legging is where illegal copies of dvd’s, videos etc are made and sold. It is considered as distribution misbehaviour as a pricy one. Counter fitting of brands is also distribution misbehaviour as well as pricing...
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...be non-payment of goods by the buyer or non-delivery of the goods by the seller. It is also difficult to judge the authenticity of buyers and sellers in advance, which creates a problem for eBay by having to verify the people involved in the transaction. Also, another problem would be transportation of goods from one place to another. eBay has no control on the delivery schedule of products as they have to rely on the transportation system the seller chooses. 3. How does eBay address these problems? eBay addresses these problems by insuring the buyers for non-delivery/damaged delivery of products. It also establishes in-house fraud prevention and escrow services to prevent fraudulent transactions. eBay also has one of the best payment mechanisms in the industry. Further, it blocks people for future transactions who have committed frauds on the website. 4. What are the contracting costs at eBay? The costs would be costs related to website maintenance, costs...
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...to types of insurance that would be relevant to my professional future. The first site that I chose to research was “http://smallbusiness.findlaw.com/liability-and-insurance/businessliability.html”. This website deals with Business Liability, and within that are a plethora of areas so i’ll keep it simple and cover four. They are An Employer’s Liability for Employee’s Acts, Tortious Interference, Driving on Company Time, and Protecting Customer Data. An Employer’s Liability for Employer’s Acts- This category stood out to me because working in the food industry you will always find a big laminated poster of all of the employee’s rights and acts. In-fact I believe it is required by law that all businesses display an updated version. One of the most interesting facts that I read was that the Employer rather than the employee is responsible for the employees actions in the event there is an incident. Why you ask? Well there are two reasons why. First, plain and simple, “employer are seen as directing the behavior of their employees and accordingly, must share in the good as well as the bad.” This may sound brash but on the other hand, the employer reaps the rewards of an employees labor in the form of profit . The second reason is that when a workplace injury or incident occurs, the legal system wants to get as much compensation for the victim in the most effective way, and that is to go after the employer. Employers are more likely to have insurance coverage at...
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...possibilities of loss or no loss,” and speculative risk is described as a “situation in which either profit or loss is possible” (Rejda, 2008, p. 6). Based on what you know about these types of risk, why do private insurers typically refuse to insure speculative risks? How does the law of large numbers affect speculative and pure risks? Discuss why personal, property, and liability risks are pure risks and provide examples in your response. Week 1 DQ 2 Recall that insurance creates benefits and costs for society. Review some of the benefits of insurance outlined in Ch. 2 (pp. 28–29) of the text. Compare those benefits with the costs of insurance described on the Web site for the Coalition Against Insurance Fraud at www.insurancefraud.org. Click on the Consumers button followed by the Useful Link and then click on the Learn About Fraud link. According to the Web site, how much does insurance fraud cost Americans each year? How are individuals and families impacted by insurance fraud? Why should the benefits and costs of insurance matter to you? In your opinion, do the benefits outweigh the costs or do the costs outweigh the benefits? For more Assignments visit:...
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...Section 4 quiz Which of the following describes prior approval as a type of rating law? The insurer files policy rate information with the Department of Insurance. After filing, the insurer delivers evidence that the rates proposed are reasonable and fair. Then the insurer waits (30-60 days) for approval. A subsequent violation of a cease and desist would result in: license suspension Which one of the following is not one of the three principal parts to the privacy requirement of the Gramm-Leach-Bliley Act? Credit Reporting Which of the following is a responsibility of the Commissioner? To enforce the law of insurance. Which of the following statements about insolvency is TRUE? An insurer cannot escape the condition of insolvency by being able to provide for its liabilities and reinsurance of all outstanding risks. Rates shall remain in effect if they are: all of the following Which of the following is a penalty for violating the Insurance Information and Privacy Protection Act? $50,000 fine for violations committed with regularity showing they are a general business practice Who administers the California Administrative Code of Regulations? Commissioner Which of the following is NOT a type of rating law? Legal Competition What is the role of the Commissioner and the Department of Insurance in relation to consumers? The Commissioner and the DOI are responsible for regulating the conduct of agents and insurers. Which court case reversed the...
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...The presence of fraud in the insurance industry is not an unknown one. Health insurance seems to have large number of these fraud cases. A larger point of concern is that as per statistics, 90% of the insurance frauds come from health policies itself. Since the key motive for every fraud is financial profit, there are no exceptions to the people who are involved in it. The involvement of these people in these cases could range from the customer, to the agent, member of hospital in question, or even the employee of the insurance company itself. COMMON OCCURRING FRAUD IN THE INDUSTRY Health frauds can be broadly divided into hard frauds and soft frauds. Each of these categories consists of situations ranging from misinterpretation of facts, to fabrication of documents, and even situations including inflation of claims. Here are some of the malpractices that the industry comes across: * Misrepresentation of facts: This is one of the largest frauds; a case qualifies as misrepresentation when the applicant is completely aware of inaccuracy of the statement provided. The most commonly falsely stated details are regarding the details of medical condition, incorrect personal details such as name, age, identity or even information such as medical history, past claim information and so on. * Fabrication of documents: It is commonly noticed that it often acts as frequent form of fraud related activities that the industry is facing now a days. These documents range from those regarding...
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...How to Submit the Required Documentation DO NOT FAX THIS PAGE Choose an option (Online or Fax) and follow the steps Online (Recommended) 1 Print, fill out and sign the Sworn Affidavit & Proof of Loss Statement. Found on page 2 of this document. 2 Scan or take pictures of both the completed affidavit and your valid photo ID. Acceptable forms of photo ID: valid driver’s license, passport, federally issued ID card or matricula consular ID. 3 Upload both documents at phoneclaim.com/verizon-uploader Fax 1 Print, fill out and sign the Sworn Affidavit & Proof of Loss Statement. 2 Photo copy your valid photo ID and handwrite your Claim ID number on the paper. 3 Fax both documents to 1-877-595-1399. How to prevent delays in processing your claim The document is marked with a barcode that is specific to your claim. Using a photocopy with an incorrect barcode will delay your claim Make sure you have a valid photo ID • Acceptable forms of photo ID: valid driver’s license, passport, federally issued ID card or matricula consular ID • Unacceptable forms of ID: student ID, work ID, birth certificate and Social Security card • Name on the ID must match name of the Verizon Account Owner/Account Manager who completes the Sworn Affidavit & Proof of Loss Statement • If name does not match, then you may need to provide additional documentation • The ID cannot be expired. If the ID appears altered, forged, illegitimate or unreadable, we will not be able to proceed with your claim Make sure...
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...THE FRAUD INVESTIGATION PROCESS I. The fraud investigation process involves systematically A. The engagement process B. The evidence process C. The reporting process D. The loss recovery process II. The engagement process A. Analyze data B. Create Hypotheses regarding a possible fraud C. Test hypotheses D. Refine and amend hypotheses E. Fraud theory is supported by the evidence III. The evidence collection process A. Physical evidence, Collect physical and documentary evidence B. Collect documentary evidence C. Collect observational evidence D. Collect interview evidence 1. The initial interviews are conducted with the most remote suspects 2. The investigator then conducts additional interviews that are successively closer to the suspects 3. With the prime suspect being the last person interviewed IV. The fraud investigation engagement process A. Initial report 1. Includes the initial information used to justify the investigation 2. The initial information should be included in a unified case file 3. The incident report can serve as probable cause for law enforcement 4. The incident report can provide proof the suspect is not being singled out because of illegal discrimination or in violation of collective bargaining rights B. Make notifications and evidence 1. Routine incident reports may be routed to a predetermined department ...
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...concerns to increase their income from investments and improve their health. The scams profiled include home-improvement projects, where a person takes the victim's money but does not perform the work promised; investment frauds and controlling their money for the future; and health and medical scams, which promise the equipment and service that do not perform as advertised. Also, research was taken from a survey from a rehab center with most of them senior citizens. The primary advice for preventing such white-collar crimes is to never give money for a product, service, or investment based upon a person's or business promise without first conducting a thorough background check. Key Terms: Senior Citizen, White Collar Crime, Prevention, Con Artists White Collar Crime against Senior Citizens Senior citizens are some of the most vulnerable targets when it comes to fraud and scam within white collar crime. There are many reasons why many people target the senior citizens and elderly mostly including but not limited to: because they are too polite and have good manners. For example, the elderly will usually not say no to people they are talking to. One of the main reasons that senior citizens have a problem is when they do find out about the scam and/or fraud; they are too embarrassed to report to the police or even their family members. This paper will focus on why the elderly are being targeted, the different types of white collar crime committed against them, and how they...
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...Fraud of ZZZ Best Company The ZZZ Best was the carpet cleaning company that was started by 15 year old Barry Minkow in 1982. He was inspired to enter into this industry by his mother when he was 12 years old. His mother was working as a telephone solicitor for a small carpet cleaning firm. Though most of the companies in carpet cleaning industry were legitimate, the nature of this business attracts many seedy characters of the malpractice. There are no barriers for any entry even no license was required. It was too easy that a 16 year old boy can start this business with his new driver’s license. The boy started his business as “rug sucker”. Minkow started his business named ZZZZ Best Carpet Cleaning Company in Reseda, San Fernando Valley, California. In the beginning stage Minkow ran his home based business out of his parent’s garage. Minkow soon realized that a small carpet cleaning business grew rapidly in next five years, but Minkow realized that it was difficult to earn from this business. To make earning better he had to face the cutthroat competition. The young boy had to face customer complaints, bad checks, and nagging vendors also demanding payment. And within very short time phrase he faced the fact of shortage of working capital. And moreover because of Minkow’s young age and the fact that ZZZZ Best was only marginally profitable business. All the local banks refused to give him loan. So, this teenager was looking for some easy ways of earning. Like check kiting...
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