Premium Essay

Opportunity and Prospective Fraud

In:

Submitted By Brody78
Words 794
Pages 4
Opportunity Perspective for Fraud 1

Running Header: OPPORTUNITY PERSPECTIVE FOR FRAUD

Opportunity Perspective for Fraud

Opportunity Perspective for Fraud 2

Health care fraud, categorized under white-collar crime, refers to the filing of false health claims to get a profit. This is done when corrupt and untruthful provider or member maliciously submits or makes someone else to file information that is misleading. There are many forms of such deceptive health care schemes where a health care practitioners and members are involved. The opportunity to commit frauds specifically in the healthcare in industry is considered to be looking any employee in the eye due to the ease of getting away with it. With the ethical and moral issues that have plagued the healthcare industry the commission of fraud by my healthcare workers is one of the most common. Too many cases of healthcare fraud had been done unnoticed and so many healthcare workers have become rich. While there are some fraudulent activities that have been caught, there are still many opportunities that present themselves for every healthcare worker and professional to challenge their ethics, morals, and values.

One example of a health care fraud by a provider involves billing patients for services that were never rendered to them. Some doctors would send Medicare or Medicaid a bill for a clinical procedure that never happened. Dentists bill for extractions that were not performed, or nursing homes may bill for supplies that were not bought or used. With the bills submitted, false receipts or records are made to back up these claims. Billing for procedures or services that are unnecessary can also be another type of fraud. According to Cady (2007, p. 57) these facilities (hospitals,

Similar Documents

Premium Essay

Amazon - Pros and Cons

...difference. Amazon is widely known to use the internet as the sole method for selling extensive selection of goods to its consumers. Amazon has grown from a book seller to a virtual Wall Mart of the Web selling diverse products. Amazon’s growth and diversification of business offers the following advantages: 1. Cost Leadership is pursued by Amazon.com by differentiating itself primarily on the basis of price. Due to this strategy, Amazon.com always makes sure that it offers the same quality products as other companies for a considerably less price. 2. Cost Savings: Amazon’s business strategy has helped it reduce costs associated with operations and staffing. A reduced cost gives increased revenue. 3. Provides current and prospective customers with different design, quality or convenience. Amazon.com always selects a differentiator that is different among the competitor. So, Amazon.com consumers can recognize and differentiate its product. 4. Existing expertise, knowledge and resources in the company is a major advantage when expanding into new activities 5. Provide better risk control through no longer being reliant on a single market or product. 6. In case of unrelated diversification as...

Words: 1748 - Pages: 7

Premium Essay

Phising and Online Bank Fraud

...PHISHING & ONLINE BANKING FRAUD By, Aditya Ravishankar 5-BBA-LLB ‘B’ 1216452 School Of Law, Christ University TABLE OF CONTENT 1. Abstract ...2 2. Introduction ...3 3. Statement of Problem ...3 4. Scope and Objective ...3 5. Fraud …4 6. Online Banking …5 7. Banking Fraud using Technology …6 8. Cyber Crime & Online Banking Fraud …6 9. Phishing …7 10. Classification of Phishing ...8 11. Indian Scenario …11 12. conclusion …12 Abstract Nowadays, almost every bank provides its clients with access to their accounts over the Internet Banks provide a different range of financial services through their Internet banking channels. Different financial Internet banking applications mostly contain money transferring services, investment services (stock, bond, and mutual funds) and currency exchange services. However, as new technologies upset traditional power balances and so does the Internet. The Internet empowers everyone including cybercriminals. Advancement of technology and rapid progression of the hackers’ ability to access various users’ systems maliciously altered their motivations from curiosity to financial motives. Thus Financial Fraud is on rampant increase. This paper focuses on Online Banking Fraud in a general perspective and also looks into...

Words: 3597 - Pages: 15

Free Essay

The Worldcom Fraud

...AVOIDING INVESTMENTS IN FRAUDULENT COMPANIES: THE WORLDCOM FRAUD Introduction The purpose of this report is to investigate and discuss the accounting fraud that occurred at WorldCom in order to recommend improved strategies to Berkshire Hathaway’s management for avoiding investments in companies with fraudulent financials. Accounting fraud is a crime committed by high level employees at an organization to manipulate the organization’s financial statements and intentionally disguise company performance. The fraud is committed without the knowledge of owners (shareholders and investors) to benefit the individuals perpetrating or committing the fraud and results in a negative impact on the owners. This report will give a brief background on WorldCom and the telecommunications industry, and then discuss the details of the WorldCom accounting fraud in order to provide relevant recommendations to Berkshire Hathaway, Inc. for mitigating future losses due to investing in fraudulent companies. We expect management to become more knowledgeable regarding high fraud risk investments and therefore make better informed investment decisions. Recommendations to Berkshire Hathaway include improving current risk assessment procedures and enhancing investment policies. WorldCom and the Telecommunications Industry WorldCom was the leader of the telecommunications industry during the 1990’s; in 2000, WorldCom was the 25th largest company in the world (Anderson, 2013, p. 48). The...

Words: 3453 - Pages: 14

Premium Essay

Forensic Accounting

...Abstract   In combination between my experiences and life learning knowledge in a discussion topic of defining forensic accounting; I will be sharing with you my life knowledge in key specific areas within the fraud examination. I will also discuss my views of what is forensic accounting and its importance of this field. In addition; I will be delving in my definition of the fraud triangle and how I would utilize it in today cases. Going forward, I will explain the importance of the fraud triangle in fraud examination cases as well as I will give an explanation on my belief of how the fraud examination has an inevitable part today and along with how it works at the same point in time. I will finalize this discussion with the requirements needed to become a forensic accountant in the present state of Florida that I reside in.                             Definition of Forensic Accounting Forensic, a word that ignites the search for clues to find the perpetrator 's intent and truth in a criminal case. In the topic of forensic accounting, it brought to my attention of a T.V. show that I have recently watched a few nights ago. The show was called Forensic Files on the HLN network. The particular case was about on how investigators of a police department were working on a murder case. They were working with different specialized groups of examiners, doctors and specialists to help solve how the death of a man occurred. During the investigation...

Words: 1761 - Pages: 8

Premium Essay

Cost Structure Break Even Target Profile

...CHAPTER 6 Audit Planning, Understanding the Client, Assessing Risks, and Responding Review Questions 6–1 In their investigation of a prospective client, the CPAs should assess the backgrounds and reputations of the prospect and its major shareholders, directors, and officers. Thus, inquiries are made of underwriters, bankers, and attorneys that conduct business with the prospective client. Also, the CPAs are required to make inquiries of the prospect’s predecessor auditors to obtain information that might enter into the acceptance decision, such as information regarding the integrity of management. The prospect’s financial reports, SEC filings, credit reports, and tax returns are used as sources of financial background information. 6–2 The audit committee of a board of directors must be composed of at least three independent directors. Independent directors are those who are outside directors (not officers or employees) who have no relationships that might impair their independence. This would include relationships such as performing consulting services for company management. In addition, the members must be financially literate; at least one member must be a financial expert. 6–3 An engagement letter is sent to the client by the auditors to make clear the nature of the engagement, any limitations on the scope of the audit, work to be performed by the client’s staff, and the basis for computing the auditors’ fee. The engagement letter...

Words: 9715 - Pages: 39

Premium Essay

Auditing Chapter 6

...CHAPTER 6 Audit Planning, Understanding the Client, Assessing Risks, and Responding Review Questions 6–1 In their investigation of a prospective client, the CPAs should assess the backgrounds and reputations of the prospect and its major shareholders, directors, and officers. Thus, inquiries are made of underwriters, bankers, and attorneys that conduct business with the prospective client. Also, the CPAs are required to make inquiries of the prospect’s predecessor auditors to obtain information that might enter into the acceptance decision, such as information regarding the integrity of management. The prospect’s financial reports, SEC filings, credit reports, and tax returns are used as sources of financial background information. 6–2 The audit committee of a board of directors must be composed of at least three independent directors. Independent directors are those who are outside directors (not officers or employees) who have no relationships that might impair their independence. This would include relationships such as performing consulting services for company management. In addition, the members must be financially literate; at least one member must be a financial expert. 6–3 An engagement letter is sent to the client by the auditors to make clear the nature of the engagement, any limitations on the scope of the audit, work to be performed by the client’s staff, and the basis for computing the auditors’ fee. The engagement letter...

Words: 9695 - Pages: 39

Premium Essay

Fraud Examination

...Questions 1. Fraud always involves deception, confidence, and trickery. The following is one of the most common definitions of fraud: a. “Fraud is a generic term, and embraces all the multifarious means which human ingenuity can devise, which are resorted to by one individual, to get an advantage over another by false representations. No definite and invariable rule can be laid down as a general proposition in defining fraud, as it includes surprise, trickery, cunning and unfair ways by which another is cheated. The only boundaries defining it are those which limit human knavery.” Fraud is deception that includes the following elements: 1. 2. 3. 4. 5. 6. 7. 3. a. Employee Embezzlement: In this type of fraud, employees deceive their employers by taking company assets. Embezzlement can be either direct or indirect. b. Management Fraud: Distinguished from other types of fraud both by the nature of the perpetrators and by the method of deception. In its most common form, management fraud is deception perpetrated by top management’s manipulation of financial statements. The victims of management fraud are typically stockholders, lenders, and others who rely on financial statement information. c. Investment Scams or Consumer Scams: A type of fraud that is perpetrated when fraudulent and usually worthless investments are sold to unsuspecting investors. d. Vendor Fraud: Perpetrated by vendors; comes in two main varieties: fraud perpetrated by vendors acting alone, and fraud perpetrated...

Words: 1408 - Pages: 6

Premium Essay

Goodner Brothers Case

...Goodner Brothers Case 1. In most fraudulent acts three circumstances lead to such crimes being committed, and should be considered when carrying out risk assessment. These conditions are an incentive, an opportunity, as well as a rationalization; the three make up what is known as the Fraud Triangle. The three circumstances are present throughout the fraudulent acts of Woody Robinson. For instance, Woody had a rampant gambling addiction that was developed throughout college, which had led him to accumulate a debt of over $50,000, some of which was owed to his good buddy, Al Hunt. In addition he was behind on mortgage payments, had maxed out credit cards, as well as received threats from two bookies he was in debt to; all of which could serve as an incentive for Woody to steal tires from his employer, Goodner Brothers. Next an opportunity for Woody to commit fraud must be recognized.Goodner Brothers held a dominant market share due to undercut competitors' prices, as well as high volume sales stressed by upper management. This strategy yielded a much lower gross profit margin than Goodner's competitors, and drove them to undercut their own operating expenses, such as internal controls. In addition to the lack of internal controls, Goodner Brothers had no separation of powers within the company. With an overwhelmed accounting system, sales representatives were allowed to enter their sales records directly into the accounting records. Not only did the sales representatives have...

Words: 938 - Pages: 4

Premium Essay

Case 1.1

...je C t ive s [1] To c a s e 1.1 Mark S. Beasley · Frank A. Buckless · Steven M. Glover · Douglas F. Prawitt help students understand the process of considering a new prospective audit client and the factors that auditors commonly consider in making the acceptance decision. [2] To give students experience in computing and interpreting preliminary analytical procedures commonly used in obtaining an understanding of a prospective client during the client acceptance decision process. [3] To raise issues relating to auditor independence in the context of client acceptance, both in terms of financial interests and the provision of non-audit services. To illustrate the subjective and sometimes difficult nature of the judgments involved in the client acceptance decision, and to give students the opportunity to justify a recommendation on client acceptance in the presence of both significant positive and negative factors. [5] To help students understand how information gathered in the client acceptance process can help the auditor in planning the audit if the client is accepted. [4] KEY FACTS ƒƒ The student takes on the role of a newly promoted audit manager recently given the task of considering factors and making a recommendation with respect to the acceptance of a new prospective client. The request to consider the engagement was received two weeks past the client’s fiscal year-end. ƒƒ The accounting firm, Barnes and Fischer, LLP, is a medium...

Words: 4495 - Pages: 18

Premium Essay

Internet Fraud: an Overview of Classifications, Government Actions, and Consumer Protection

...Internet Fraud: An Overview of Classifications, Government Actions, and Consumer Protection December 14, 2006 Internet Fraud: An Overview of Classifications, Governmental Actions, and Consumer Protection Internet fraud is an increasing threat to our technological society, which thrives on the advances and benefits of the Internet and e-commerce. With the increased growth and dependence of the Internet, creative individuals have found ways of conveying fraudulent schemes as legitimate goods and services. Not only does Internet fraud cause harm to individuals and institutions, but it also damages the consumer confidence of valid Internet businesses and e-commerce. There are many forms of Internet fraud which Internet patrons need to be aware of and cognizant of. This paper will explore major classifications of Internet fraud, provide information on how to deal with Internet fraud, relay actions taken by the government to thwart Internet fraud and prosecution thereof, and also take a detailed look into one type of Internet fraud especially, identity theft. According to the Department of Justice (http://www.usdoj.gov/criminal/fraud/text/Internet.htm), Internet fraud is any type of criminal scheme that uses one or more components of the Internet to present fraudulent solicitations to prospective victims, to conduct fraudulent transactions or to transmit the proceeds of fraud to financial institutions. Major types include; online action and retail scams, business opportunities...

Words: 3658 - Pages: 15

Premium Essay

Skilling vs Us

...crashed into bankruptcy, and its stock plummeted in value. After an investigation uncovered an elaborate conspiracy to prop up Enron’s stock prices by overstating the company’s financial well-being, the Government prosecuted dozens of Enron employees who participated in the scheme. In time, the Government worked its way up the chain of command, indicting Skilling and two other top Enron executives. These three defendants, the indictment charged, engaged in a scheme to deceive investors about Enron’s true financial performance by manipulating its publicly reported financial results and making false and misleading statements. Count 1 of the indictment charged Skilling with, inter alia, conspiracy to commit “honest-services” wire fraud, 18 U. S. C. §§371, 1343, 1346, by depriving Enron and its shareholders of the intangible right of his honest services. Skilling was also charged with over 25 substantive counts of...

Words: 40397 - Pages: 162

Premium Essay

Accounting Information System Report

...REPORT ON REDUCING COMPUTER FRAUD Name: ZHAOJUN HU Student NO: 20137098 Class: TACC403 Accounting information system Submission date: September 20, 2013 TABLE OF CONTENTS EXECUTIVE SUMMARY i INTRODUCTION 1 IS SOFTWARE LICENSING ANTISOCIAL?..................................................................2 COMPUTER SECURITY MEASURES 3 WOULD THE REMOVAL OF COMPUTER SECURITY MASURES REDUCE THE INCIDENCE OF COMPUTER FRAUD? 5 CONCLUSION AND RECOMMENDATIO 6 REFERENCES 8 EXECUTIVE SUMMARY The aim of this report is to discuss the various methods of reducing computer fraud and to find out whether the computer security measures is necessary. In the main body of this report discuss about whether the software licensing is antisocial or not, the development of computer security measures, ethic teaching for the computer users and the effect of reduce computer security measures. The reports finds that software licensing protect the effort of the licensor and provide the financial support for them to develop new product and Computer security measures are effective way to reduce the computer fraud also is necessary. Without computer security measures the computer fraud will increased and the effect of using ethical teaching to reduce computer fraud is limited. The report conclude that reducing computer fraud not only depends on students self-moral cultivation but also require for protection from computer security measures. In addition, it is recommended...

Words: 2025 - Pages: 9

Premium Essay

Misbehaviour

...Are people born to be bad? I think that this statement summed up this week's area of concern on the topic "Biology and Misbehaviour". From my personal understanding prior to the class, I have always thought that any misbehaviours are usually trigger or due to the situational factors such as poor family upbringing, peer pressure, social norms and other environmental factors. This could be due my belief that people are kind in nature gathered from the first verse of a Chinese Classic text, Three Character Classic. After the discussion on the topic, I have gain a new perception on the cause or reasons that misconduct is not only attributed by situational factors but complemented by individual factors. From the readings, case presentation and class discussion, I have gain a deeper insight into three correlations between biological traits and misbehaviour, On top of that, I have also gain knowledge of how situational factors influence the correlation of the two. They are discussed in the lesson includes the correlations between physical appearance (biological) and misbehaviour, personality traits (biological) and misbehaviour, and cognitive ability (Biological) and misbehaviour. Firstly, for the physical appearance, from reading the article "Ugly Criminals", I have learnt that there is a positive correlation between being ugly looking (from the perspective of the social norm) and higher tendency in committing crime. In the study, it shows that respondents that are considered...

Words: 2316 - Pages: 10

Premium Essay

Health Information

...HIM141 Test 4 Chapters 8-10 Please completely answer the following questions. 1. What is the MPI and what types of information are contained in the MPI? MPI-master patient index, sometimes called a master person index, link a patient’s medical record number with common identification data elements, for example: patient’s complete name, date of birth, gender, mother’s maiden name and social security number. Because most health care facilities house patient records according to a medical record number, the MP becomes the key to locating paper based records in the health information department file system. Thus, the MPI is retained permanently because it serves as the key to finding the patients record, it can be automated or manual. According to the American Health Information Management Association (AHIMA), some recommended core data elements for indexing and searching records include: * Internal patient Identification * Patient Name * DOB * DOB qualifier * Gender * Race * Ethnicity * Address * Alias/pervious name * SS# * Facility identification * Universal patient identifier (if available) * Account number * Admission date * Discharge date * Service type * Patient disposition 2. What are registers and indexes? Registers and registries contain information about a disease or event and are maintained by individual health care facilities, federal and state government agencies and private organizations...

Words: 3684 - Pages: 15

Premium Essay

15 Descriptions

...Student learning outcomes are a very important part of any training activity (video, presentation, power point, role playing, etc.), because if the training program is not effective, then students/trainees will not learn. The training methods used and the delivery style and appearance of the trainer significantly impact student learning outcomes. Training environment is also very important because there must not be distractions or uncomfortable surroundings. A good trainer must connect with the audience, engage people, effectively deliver information and meet the objectives of the training program. To ensure that I understood “student learning outcomes,” I researched this topic on multiple web-sites, including ones from the University of Washington, Ohio University, the University of North Carolina in Charlotte, California State University and Carnegie Mellon University. I also reviewed our text book to be sure elements of what we have learned throughout this course were incorporated, as well as the use of appropriate verbs for training objectives and learning outcomes (p. 86). I watched 14 training videos on YouTube and also included my own basic training experience at Fort Sill with the Georgia National Guard. Army Basic Training: In my three month basic training program for the Georgia National Guard at Fort Sill, OK., we learned a range of skills from shooting guns to physical fitness to discipline to caring for our uniforms. There also were some top tips...

Words: 2018 - Pages: 9