Insurance Fraud After tax evasion, insurance fraud is considered the highest-ranked among white-collar crimes. The original concept of insurance, as a for-profit endeavor, was to collect funds from a large number of people to pay for damages and acc Continue Reading...
Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), that by the time 2011, health care expenditure will arrive at $2.8 trillion, as well as it will bill for 17% of the Gross Domestic Product. As a result Continue Reading...
Fraud and Abuse Case Healthcare fraud and abuse continues to threaten the country, costing the facility billions of dollars per year. Brodeur, (2007) stated that fraud is something difficult to understand because it is a contagious issue. Healthcare Continue Reading...
However, as Schwarcz notes, the reasonable expectations doctrine fails in practical use for several reasons. Whie th doctrine may have widespread support from insurance law commentators, "Only a handful of state courts follow the rule, and the case Continue Reading...
CityPlus Insurance Intelligence seeks to illuminate the unknown. By definition, intelligence analysis deals with highly ambiguous situations. Despite maximum striving for objectivity, the intelligence analyst's own preconceptions are likely to exer Continue Reading...
Texas Department of Insurance illustrates why and when the Texas Department of Insurance was formed and how much it has accomplished since the time it was established. This paper highlights the number of people employed by the TDI, their annual budg Continue Reading...
Financial fraud refers to the act of deceitfully and illegally taking money or property for personal gain. It is an ever-evolving problem with serious implications for individuals, businesses, and the economy at large. The variety of fraudulent activ Continue Reading...
Fraud is a growing problem in today's business world, and this article chronicles the capture of a purchasing manager defrauding his organization. The author follows step-by-step the accountant called in to decipher just how the manager was defraudi Continue Reading...
Fraud and abuse present significant problems for the healthcare sector, leading to both financial losses and reduced quality of care. The outcomes of fraud and abuse are similar; but fraud and abuse are legally differentiated based on motive. Accordi Continue Reading...
Insurance Considerations Discuss the basic types of homeowners policies that are used today. When is each type most appropriate? Homeowners insurance policies are for people who own or are buying their own home and for people who rent a home or apa Continue Reading...
Rite Aid Fraud Over the years, there have been numerous cases of financial fraud perpetuated within the organizational mainstream of major companies. Financial fraud is often a well-coordinated sort of white-collar crime that often -- but not always Continue Reading...
Health Insurance Portability and Accountability Act (HIPAA) Discuss whether there has been a violation of Health Insurance Portability and Accountability Act (HIPAA)? There are no court rulings that can shed light on the issue. However going by the Continue Reading...
Financial Fraud Fannie Mae Review of Fraud Schemes within Fannie Mae 1998-2004 Scope The agency found the fraud understatements of earnings and illegal gratuities that led to accounting violations and inability to meet Wall Street goals. The inve Continue Reading...
High Insurance Portability Health Insurance Portability & Accountability Act Some hope was given for the current legal environment to become better defined for health-care providers when Health Insurance Portability & Accountability Act (HI Continue Reading...
In the case of pill mills, participating physicians and pharmacists bill insurance companies or Medicare for prescription drugs, allowing participating beneficiaries to resell those drugs to criminal middlemen. The pharmacy then repurchases the drug Continue Reading...
Mortgage Fraud If a rash of armed bank robberies swept across America next year, and if in these robberies criminals absconded with $30 billion dollars, one may be certain that a public panic would ensue. The banking system would likely be changed f Continue Reading...
Medicaid and Medicare Fraud Describe health news story combating health care fraud Medicare Medicaid• Examine evaluate corporate structure governance, culture, focus social responsibility • Recommends Medicare and Medicaid fraud: An ove Continue Reading...
President George Bush proposed a two part strategy with initial implemented drug coverage to low-income beneficiaries coupled with a White House task force to develop a plan to reform Medicare (Health Policy, 2001). Under this plan beneficiaries wit Continue Reading...
Obama Urges Tougher Laws on Financial Fraud In the wake of the Wall Street bank bailouts and the various security fraud cases that have occurred nationally the Obama administration has been under pressure to enact new legislation that effectively pr Continue Reading...
EU's Current Anti-Fraud Strategy For some time now, the issue of fraud and corruption in public service has been an issue of concern. This has forced many organizations to establish strategies aimed at detecting and minimizing the occurrence of such Continue Reading...
John Mackey said, "Under an alias to avoid having his comments associated with the Company and to avoid others placing too much emphasis on his remarks." He used the pseudonym Rahodeb after his wife Deborah. (Wikipedia). RAHODEB John Mackey posted Continue Reading...
Fraudulent activities such as these resulted in violations under the act, including a fine of not more than $25,000.00 or imprisonment for not more than five years, or both. Analysis of Current Fraud legal analysis of the current fraud committed in Continue Reading...
, 2008). There are two formats of insurance coverage that AIG specializes in: 1. Auto Insurance 2. Travel Insurance Auto insurance The primary profits and insurance coverage offered by AIG for auto insurance services were through its subsidiary b Continue Reading...
Of course, the idea of what constitutes risk is somewhat problematic, as it could be argued that the definition of risk varies from investor to investor and company to company. Strictly speaking, the accounting regulations of the Federal Accounting Continue Reading...
Goldman Sachs Forensic accounting Fraud at Goldman Sachs The recent recession and financial scandal brought to light many unethical, illegal, and quasi-legal practices of the major investment firms. One example of this was the Goldman Sachs securi Continue Reading...
HIPAA (the Health Insurance Portability and Accountability Act of 1996) and Recent Changes On August 21, 1996 a new law was signed called the Health Insurance Portability and Accounting Act of 1996, which is abbreviated as HIPPA (HEP-C, 2003 & R Continue Reading...
On-the-Job Problem-Solving: Insurance Billing ManagersOne of the unfortunate and more challenging aspects of the human condition is the unending series of problems that must be solved. Fortunately, humans are hard-wired for this enterprise. For insta Continue Reading...
Companies that stress financial results measured as earnings before interest, taxes, depreciation and amortization, should be one potential red flag for regulators (Krantz 2002:2). Because it is extremely difficult for ordinary investors to careful Continue Reading...
The safe harbors do not cover every area of permissible behavior, and an arrangement may not qualify as a safe harbor, but still not subject someone to the risk of prosecution. In fact, the courts have interpreted the Federal Anti-Kickback Law rela Continue Reading...
("Protecting the Privacy of Patients' Health Information," n. d.) the variations HIPAA necessitates would be sufficient and the changes would be accompanied by remarkable uneasiness in several respects. Functioning in the type of high- Continue Reading...
I'm sickened and saddened by what I've become, and I'm staggered by the speed at which I've fallen" (Grisham, 1996, p. 140). Much of the book is realistic, but any good work of fiction takes license in some areas, and this work does, as well. A lawy Continue Reading...
ACA and EMS The implementation of the Affordable Care Act (ACA) is sure to change the way EMS operate in the coming years. Accountable Care Organizations (ACO), for instance, are now responsible for overseeing how reimbursements are paid out to thos Continue Reading...
Affordable Care Act What is the ACA? The 2010 Affordable Care Act or the PPACA (Patient Protection and Affordable Care Act - HR3590), nicknamed Obamacare, is the latest American healthcare reform legislation. The PPACA encompasses the Patient Prot Continue Reading...
(Mechanic, 2006, p. 11) (Sparrow, 2000, p. 9) Lastly, low reimbursement may be a the center of concerns about cost shifting to private insured persons, private insurance reimbursement contracts and those with the least bargaining power private pay p Continue Reading...
Patient Protection Affordable Care Act (PPACA) legislation is patently an improvement to the health care delivery system. The mere fact that thousands upon thousands of people are receiving healthcare and medical service through the Affordable Care Continue Reading...
Assessing the ability of these individuals to perform basic tasks in their daily lives can also have much significance (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Many older Americans are able to feed and clothe themselves without apparent p Continue Reading...
The dilemma is often easier to resolve once those emotions and assumptions are put into their rightful context. For this paper, critical thinking came into play was logic. It is understood that initially the nursing profession had issues with HIPAA Continue Reading...
Businesses and other establishments have now turned to fraud detection as a way to address their fraud issues. "In contrast fraud detection involves identifying fraud as quickly as possible once it has been perpetrated. In practice it must be used Continue Reading...
Other people simply want to live beyond their means and see committing fraud as the way to receive extra money so they can continue to live a lifestyle they would otherwise not be able to afford. If they are angry at their managers or hate their job Continue Reading...
The experiences of seniors within the healthcare delivery system will alter how all Americans view healthcare. The healthcare delivery systems and overall organizational structure in the United States has been slow to adjust but that rest of the wo Continue Reading...
