Monthly Archives: September 2017

DOJ Announces Charges Against 400 People for $1.3 Billion in Health-Care Fraud

Posted by Devaki Sidhaye.

Recently department of Justice announced largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 individuals, including 115 doctors, nurses and other licensed medical professionals. Their involvement in health care fraud scams totaling approximately $1.3 billion in false billings. As per the department, many of the charges were related to medical professionals illegally prescribing opioids and other prescription narcotics, some of which were then sold on the street. Furthermore, according to federal officials, a rehab facility in Palm Beach, Fla., recruited addicts with gift cards, drugs and visits to strip clubs, billed the government for over $58 million in false treatments and tests. A clinic in Houston allegedly gave out prescriptions for cash. Some falsely billed Medicare and Medicaid. Narcotics officers have arrested schoolteachers, doctors, nurses and fellow law enforcement personnel (Merle, 2017).

According to the Centers for Disease Control and Prevention, approximately 91 Americans die every day of an opioid related overdose. Attorney General Jeff Sessions said at a news conference that, “One American dies of a drug overdose every 11 minutes and more than 2 million Americans are ensnared in addiction to prescription painkillers.” He further said in assurance that, “We will continue to find, arrest, prosecute, convict and incarcerate fraudsters and drug dealers wherever they are.” Health and Human Services Inspector General Daniel Levinson added that, “Health care fraud is a reprehensible crime, it not only represents a theft from taxpayers who fund these vital programs, but impacts the millions of Americans who rely on Medicare and Medicaid” (Merle, 2017).

This approaches a larger debate about how the country should address the government estimates are addicted to opioids. Public health authorities urge doctors to cut back on the prescriptions they offer. States struggling with the shortage of treatment has proposed roll back of the Affordable Care Act’s expansion of Medicaid (Merle, 2017).

This crisis represents a massive public health challenge that requires a broad-based, multi-pronged response from public health agencies and law enforcement. Physicians, pharmacists and citizens all can play a role in identifying and preventing nonmedical use of prescription drugs. Doctors and other healthcare professionals who prescribe these drugs need to be educated about responsible prescribing of opioids and about safe, effective alternatives that are not addictive and presently available (Young, 2016).

Even though law enforcement officials use advanced investigative methods to uncover the different actions health care fraud happens, they can’t fight these crimes alone. Individual can help remove these people responsible for wrongdoings by protecting their health insurance identification number, social security number, looking through the statements for medical services he didn’t receive, and reporting to authorities on recognizing the signs of possible fraud (Outreach, 2012).

For the protection of each person of the country as well as for the economic strength it is essential to destroy all traces of health care fraud. Health care frauds damage billions of dollars of the nation; mislead general public in the courses of actions, and innocent people become victims of white-collar crime.

Devaki is an MS Accounting student at the Feliciano School of Business, Montclair State University, Class of 2018.

References:

Merle, S. H. (2017, 07 13). DOJ announces charges against 400 people for $1.3 billion in health-care fraud. Retrieved from www.washingtonpost.com: https://www.washingtonpost.com/news/business/wp/2017/07/13/doj-announces-charges-against-400-people-for-1-3-billion-in-health-care-fraud/?utm_term=.f9b959fbfea6

Outreach, E. &. (2012, 04 23). How to Protect Yourself From Health Care Scams. Retrieved from www.aarp.org: http://www.aarp.org/health/medicare-insurance/info-10-2010/fightfraud.html

Young, L. (2016, 03 04). There’s no debate – America’s opioid epidemic is undeniable. Retrieved from www.pennlive.com: http://www.pennlive.com/opinion/2017/09/heres_what_you_need_to_know_ab_5.html

 

 

 

 

The Summary of “Uber Investor Sues Travis Kalanick for Fraud” Article

Posted by Nora Shelbi.

In the article, Isaac (2017), discussed the issue of the Uber investor and claimed that Travis got involved in the material misstatement and fraudulent trading.  As per the investors, it has been declared that such fraudulent activity has been done with the intention to get the outside control of the board; and, he is involved in the breach of contract and breach of duty. Also, the investors are claiming that Mr. Kalanick’s “overarching objective is to pack Uber’s board with loyal allies in an effort to insulate his prior conduct from scrutiny and clear the path for his eventual return as C.E.O.”

The author of the article has declared that all the fraudulent activities which have been done by Mr. Kalanick is mainly due to restoring his position as the CEO and for this purpose, he is using the fraudulent ways which are not allowed at all in the corporate environment. The persons who were in favor of him have declared that he does not want to be the chief executive officer of the company, but others have said that he is doing this just to achieve the control without even having the title of the chief executive officer of the company.

There are many other claims, which are made, including an atmosphere of sexual harassment at workplace. The company is also sued by the sister company of Google for stealing the trade secrets of company, Waymo. Such issues concerning litigation against the company as well as its officials are not in favor of the company. It is deteriorating the image of the company, as well as, dissatisfying the investors to a greater extent. (ISAAC, 2017)

Nora is a graduate accounting student at the Feliciano School of Business, Montclair State University.

Reference:

ISAAC, M. (2017, Aug 10). Uber Investor Sues Travis Kalanick for Fraud. Retrieved Sep 20, 2017, from The New York Times: https://www.nytimes.com/2017/08/10/technology/travis-kalanick-uber-lawsuit-benchmark-capital.html

 

 

 

Prevalence of Health Care Fraud

Posted by Sabrina Gilliam Formey.

Health care fraud may be more extensive than fraud in other industries because deception branches from an assorted group of players; those players being insurance companies, pharmacists, providers, suppliers, health care vendors, health care provider employees, physicians, specialists, and patients.  To compound the problem, some of those players are not only acting independently, but also participating in fraudulent activities within a network, or organized crime rings, and or with computer hackers who are unjustly profiting from committing health care fraud.  As a brief example, insurance billing claims that a facility submitted for a number of Alzheimer’s patients receiving “group therapy”, when they were actually placed in a room to watch the movie “Forrest Gump”, doesn’t scratch the surface on how persistent health care fraud has been; and how it continues to morph into new dimensions, that are discovered months and sometimes years after millions of dollars have been dispersed for fraudulent claims.

Lack of public awareness about health care fraud fosters a criminal subculture of operators that swindle unjust profits for their own personal gain.  Those fraudulent activities, not only create health and safety risks, but also drive up costs for healthcare.  These costs are later transferred to patients resulting in higher costs for care: higher employer sponsored or group premiums, higher deductibles, and higher co-pays.  Additionally, there are “double jeopardy” costs that further become a burden for citizens to bear through state and federal tax increases levied to close deficit gaps for government healthcare programs.

Common Channels for Health Care Fraud

  1. Billing for services not rendered.

  2. Billing for a non-covered service as a covered service.

  3. Misrepresenting dates of service (billing one treatment date as separate dates).

  4. Incorrect reporting of diagnoses or procedures (includes unbundling).

  5. Overutilization of services.

  6. False or unnecessary issuance of prescription drugs.

“According to the Centers for Medicare & Medicaid Services (CMS), national health expenditures in the U.S. reached $2.6 trillion in 2010 – 17.9 percent of GDP.”  With the expansion of coverage of an estimated 22 million people that were previously uninsured prior to the U.S. Affordable Care Act(ACA), health fraud crime will become an undeclared war between government agencies and insurance companies that are trying to stop these crimes and the many players that are many steps ahead due to the gap in systems, lack of controls, and stratagem for auditors/investigators deployed to  monitoring claims activities and continuous oversight that would be required.

Sabrina Gilliam Formey is a graduate student at the Feliciano School of Business, Montclair State University.

Article

10 popular health care provider fraud schemes ‘Do no harm’ isn’t their motto By Charles Piper, CFE, CRT

January/February 2013

http://www.acfe.com/article.aspx?id=4294976280

 

Additional Readings

  • Health care: A ‘goldmine’ for fraudsters

January 13, 2010: 3:07 PM ET   By Parija Kavilanz, senior writer

http://money.cnn.com/2010/01/13/news/economy/health_care_fraud/

 

  • Blockchain: Putting the ‘Block’ On Healthcare Fraud, Waste, And Abuse

July 19, 2017, 08:16:38 AM EDT By Michael Scott Bitcoin Magazine

http://www.nasdaq.com/article/blockchain-putting-the-block-on-healthcare-fraud-waste-and-abuse-cm817907

 

Additional Readings

  • Health care: A ‘goldmine’ for fraudsters

January 13, 2010: 3:07 PM ET   By Parija Kavilanz, senior writer

http://money.cnn.com/2010/01/13/news/economy/health_care_fraud/

 

  • Blockchain: Putting the ‘Block’ On Healthcare Fraud, Waste, And Abuse

July 19, 2017, 08:16:38 AM EDT By Michael Scott Bitcoin Magazine

http://www.nasdaq.com/article/blockchain-putting-the-block-on-healthcare-fraud-waste-and-abuse-cm817907

University of Virginia Cyber Attack: Avoidable if Biometric Security System was Used

Posted by Stanley Bukowski.

On August 6, 1991 was when the internet, also known as the “World Wide Web”, became available to the public. At that time, cyber-attacks ever occurring, never crossed anyone’s mind. Since the launch of the World Wide Web, cyber-attacks and IT threats continue to significantly grow each year. Even though they are known to be threats to business/organizations/firms/universities, they are most importantly a threat to individuals themselves. Even though business/organizations/firms/universities may lose financial resources from cyber- attacks, individuals lose their sense of total personal privacy. Personal Privacy is a concept that is cherished and treasured for four main reasons (Brey). The first reason is that privacy must be well-adjusted to national security and public order. Secondly, it is known to be a condition that is necessary for autonomy, which allows individuals to develop their own personality through personal experiences. Thirdly, privacy is known to be a safeguard to us which shields them from external threats of exclusion and/or blackmail. Lastly, it can also provide social value as well.

In the field of computer security, one will see that it is the process of being able to counteract and detect illegal usage of a computer. Computer security deals with having the ability to act as a safeguard by fighting off cybercriminals/identity thieves that are trying to get a hold of our personal resources that we have stored on our computers. Basically, the main goal for computer security professionals is to provide the protection that is needed for the valuable information and resources that are stored on our computers. The two types of computer security systems that exist are: System Security, which protects the software and hardware of a computer from mischievous programs and Information Security, which protects three different types of data such as availability, confidentiality, and integrity (Brey).

On June 11, 2017 the University of Virginia was silently blind-sided with a cyber-attack from China, where several attackers that operated together to successfully wire transfer $996,000 to what was first an unknown, untraceable location. This attack was successful due to the fact that there was a breach of information that leaked out information that the University of Virginia was upgrading their security system and also due to the fact that the thieves stole a computer from the university that belonged to the comptroller (U.VA). Once the thieves had a hold of this information and the computer, they implanted a virus into the university’s entire IT system, which allowed them to gain access to the University’s accounts at BB&T Bank. When the virus ultimately completed the job that it was created for, they were able to steal the universities online banking credentials, commencing them to successfully complete a single wire transfer to the Agricultural Bank of China.

To most people, this would set off a red flag, especially since it was a wire transfer from a United States university to a random, unheard of bank located in China. Not only should that have been a red flag, but a red flag should also have gone off seeing that the University of Virginia had no prior records in their transfer history to wire transfer money to the bank in China. Regardless of the fact that most universities in America purchase their school supplies from across seas, they tend to always use reputable banks, where they have several prior transactions in their transfer history. Even though there is a good chance that the university may retain most of its lost, they will not receive the entire amount that was stolen.

Believe it or not, most thieves today are known to be what we call “cyber hackers.” Thieves that commit these types of crimes are the individuals, co-workers, friends, family members that you would least likely expect to commit such a crime. Before we continue any further, the next four descriptions that are listed below, are the characteristics that management of business/organizations/firms/universities should look for when trying to identify a thief (Singleton).:

  1. Reputable CharacterStudies show that you will never find a thief that disrupts the regular flow that happens daily at the working environment that they are a part of. These types of thieves will have the type of reputation at work where nothing ever seems to bother them. They will never portray or converse towards others or with others dishonest behavior and will never discuss their own personal financial issues. By doing so, management will never be suspicious that they would or ever think of stealing from the company.
  2. Collaborate with AdministrationYou will find thieves to always be individuals that continually help their co-workers out with projects. The only plot twist is–they will only help them to the point where they will not be exposed to information that management could possibly use against them. Thieves use reverse psychology and have a relaxed personality when dealing with auditors. They tend to put on a poker face and give auditors everything they need in order for the auditors to be able to complete their jobs. Thieves believe in the fact that if they behave like they have nothing to hide, auditors/management will never become suspicious of them.
  3. Work-a-holicsTaking a vacation from work will lead thieves down a one-way road, known as jail. If a thief were to take a vacation and the IRS/Auditor just happened to start an investigation while they were gone, will red flag them as the first source of why financial resources are missing. By not taking a vacation while the IRS/Auditor are conducting their investigation, there is a slimmer chance of the IRS/Auditor blaming them.
  4. Norm: SecrecyThieves know that to successfully commit corporate fraud, they need to follow the norm of secrecy. Thieves know not tell anyone within or outside the company about the future corporate fraud they are about to commit. The percentages of successfully completing corporate fraud diminish the more individuals that the thief would inform. No matter if it is their best friend, wife, brother, etc., thieves know that to successfully complete the operation, they must act as an assassin, working silently alone.

I believe that business/organizations/firms/universities that implement Biometrics Security Systems will not completely bring cyber-attacks to an end, but it will certainly decrease them to the bare minimum because it is a form of access control. Biometric Security Systems are known to be as a technique of entry in which users/individuals are recognized based on their physical individualities, personal/behavioral/biological features. Having a wide variety of alternatives to choose from, business/organizations/firms/universities have a large selection pool that they may elect from to incorporate a the type of biometrics of their choice. For example, fingerprint, retinal, & palm scanners and face recognition are just a few of the types of biometrics available. Fingerprints are now being used as access controls for smartphones because in order to unlock their phone with their fingerprint, the fingerprint must be equivalent to the fingerprint that was previously stored on the smartphones system. This prevents thieves from getting their hands on private information that is on the device. The same exact notion can be applied to the corporate world. (Lombard0).

Information of the advancement of Biometrics is spreading amongst many individuals today and is becoming more of a topic of discussion due to its popularity due to it replacing passwords with login credentials. The most recent examples of biometrics security systems is now used when individuals take the GMATS. Before entering to take the standardized test, the proctor uses a palm vein reader upon entry to ensure that the exam is not being taken by a random individual and that it is being taken by individual who signed up for the standardized test.

Years ago it would cost a business/organizations/firms/universities tens of thousands of dollars to implement such a finger print scanner into their building but today it only costs about $200 dollars to have a finger print scanner implemented into a desktop, $2,200 for a retinal scanner to be implemented at limited access doors, and $250 for a palm scanner for each room for an employee to enter their office. For example, if the company has 5,000 employees:

A. 5,000 employees * $200 finger print scanner laptop = $1,000,000
B. 5,000 employees *$250 palm scanner entrance to office room = $1,250,000
C. 5 retinal scanners * $2,200 enter limited access door  = $11,000
D. 10,005 Installment fee for Scanners *$300 (avg of all three) = $3,001,500
E. Yearly Maintenance of all three Biometric Units = $25,000

TOTAL START UP COST OF = $5,287,500

In my opinion, as a senior executive of a company, since it would only cost a company $5,287,500 to have an up-to-date Biometrics Security System, I would rather spend that amount of the company’s financial resources towards a reliable Biometrics Security System. Therefore, I would not have to worry about a cyber-attack occurring, where $10 million dollars might be stolen, customer’s private information being stolen, and then having the media portray a bad brand image for the company.

Problems will always continue to arise when dealing with technology which will lead to advantages and disadvantages of using Biometrics.

Advantages:

  1. Biometrics eliminate the need to remember/change passwords.
  2. It cannot be stolen/lost because as long as they are alive, the biometric is always available to only that particular individual.
  3. Provides a strong security for the organizations that choose to implement it.

Disadvantages:

  1. Not standardized across different entities; it varies from place to place.
  2. With technology advancing each day, the form of biometrics that a company uses may quickly become obsolete, being a costly resource to keep up to date with.
  3. Does not take into consideration the changes that may occur to people’s appearances/physical characteristics. Some forms of biometrics can be affected by people’s aging, illnesses, or even injuries.

No matter how secure and up to date we may think our security systems are, the security systems that organizations/businesses/firms use that we conduct business with, or just security systems overall, there is and always will be a loophole for a thief to discover. It only takes one thief to figure out the logistics, binary codes, etc. to outsmart a security system and get their hands on millions up on millions amounts of private information of individuals or simply just steal and wire financial resources to an unknown, untraceable location. The only possible way to almost completely stop these cyber-attacks from happening is to do R&D in Biometrics Security System Technology.

Stanley is an MBA student with a concentration in accounting at the Feliciano School of Business, Montclair State University.

Work Cited:

  1. Brey, P. (2007), “Ethical Aspects of Information Security and Privacy”, in: Security, Privacy, and Trust in Modern Data Management, M. Petković and W. Jonker (Eds.), Springer Berlin Heidelberg, pp. 21-36.
  2. “Krebs on Security.” Krebs on Security RSS, krebsonsecurity.edu/2010/09/cyber-thieves-steal-nearly- 1000000-from-university-of-virginia-college/.
  3. Lombardo, Crystal R. “6 Major Pros and Cons of Biometric Technology | NLCATP.org.” NLCATPorg. NLCATP, n.d. Web. 03 Dec. 2016.
  4. Singleton, Tommie, and Randal Wolberton. “The Top 5 CyberCrimes.” THE TOP 5 CYBERCRIMES, 2013, www.aicpa.org/InterestAreas/ForensicAndValuation/Resources/ElectronicDataAnalysis/DownloadableDoc uments/Top-5-CyberCrimes.pdf.
  5. “U.Va. Responds to Cyber Attack on Portions of IT Systems.” UVA Today, 17 Aug. 2015, news.virginia.edu/content/uva-responds-cyber-attack-portions-it-systems-0.https://news.virginia.edu/content/uva-responds-cyber-attack-portions-it-systems-0

Columbia University fined $9.5 million for Overcharging Medical Research Costs

Posted by Serkan Saka.

Have you ever thought how important it is for universities to receive government research support? As we know that reputation is also very important for all the universities. Columbia University one of the best universities in the world and a top university for medical research. Recently, however, Columbia requested research funds from National Institutes of Health (NIH) for medical research but was caught in related fraudulent activity.

According to Danielle Douglas-Gabriel’s article in The Washington Post, Columbia’s research costs were lower than what they actually received from NIH. One of the reasons is that Columbia University conducted their research off campus, but misinformed NIH that the research would be conducted on campus, which would make the research more expensive. After government investigation, Columbia University will pay $9.5 million to NIH to cover false charges (Douglas- Gabriel, 2016).

The school officially released a statement by Caroline Adelman, a spokeswoman says, “The government disagreed with the university’s approach and took the position that a lower indirect cost rate was appropriate.”(Douglas-Gabriel, 2016). On the other side the NIH’s statement says “ Money gained by such behavior deprives other research programs of funds that could yield life-altering new treatments”(Douglas-Gabriel, 2016). It is very important to inform correctly in any case. It is not important if you are a big institution or small business, as either could be involved in white-collar crime.

Serkan is a MS accounting student in Feliciano School of Business, Montclair State University, Class of 2018.

Source:
Douglas-Gabriel, Danielle. (2016, July 14). [Columbia University to pay $9.5 million to Settle Fraud Charges]. The Washington Post. Retrieved from https://www.washingtonpost.com/news/grade-point/wp/2016/07/14/columbia- university-to-pay-9-5-million-to-settle-fraud-charges/?utm_term=.f974cc316f05

Tesco Agrees to Pay $162 Million Fine Over Accounting Scandal

Posted by Alhanouf Almubarak.

This case discusses Tesco the Britain’s biggest retailer accounting scandal. In October 2014, the Serious Fraud Office (SFO) began a criminal investigation into accounting practices at Tesco. Chris Bush, (Tesco’s former managing director), Carl Rogberg (former finance chief), and John Scouler (former food commercial head) were charged with fraud over an accounting scandal after the company announced that it had overstated its first-half profit by approximately $420 million. At that time the company suspended many executives for accounting irregularities.

Some of the reasons why Tesco overstated the expected profits of the group at that time was mainly because it agreed on commercial deals with suppliers too early. The investigations against Rogberg, Scouler and Bush revealed that they purposely falsified Tesco’s digital accounting records and its draft interim accounts by the “inputting of and/or reliance upon commercial income figures which gave a false account of the financial position of Tesco.” (Butler,2017). The offenders’ crime by abuse their position and fraud accounting can lead to prison sentences of up to 10 and seven years respectively.

In 2017, Tesco has agreed to pay a fine of $162 million in addition to the compensation to settle the investigation that began in 2014 over the biggest accounting scandal in the company’s near 100-year history. The company will also pay compensation to some investors of around 85 million pounds. “We sincerely regret the issues which occurred in 2014 and we are committed to doing everything we can to continue to restore trust in our business and brand,” said Chief Executive Dave Lewis.

Alhanouf is a graduate accounting student with a certification in forensic accounting Feliciano School of Business, Montclair State University.