Bad “Yelp” Reviews Should be Protected by the First Amendment

Posted by Jen Suarez.

To what extent is defamation? From my last blog article, I defined defamation as “malicious and damaging misrepresentation,” where an organization was falsely accused of rape. However, can anyone play to the “defamation card” if they don’t like what other’s have to say? For example, Yelp.com is a website where consumers can post and rate the quality of businesses anonymously. The Rhodes Group, which is a Collin County Texas real estate firm, received a poor review on the Yelp website and is now suing on the grounds of defamation; they are requesting the name of the customer, whose username is “Lin L.” The Rhodes Group does not even believe that “Lin L.” is a real person. In fact, they openly suggest that this username belongs to someone from a competing organization, trying to ruin The Rhodes Group’s reputation. The Rhodes Group, however, is fighting in court against Public Citizen, which claims that revealing the user’s identity violates the user’s right to privacy. Though the negative Yelp review has been removed, there is no confirmation its removal was due to the impending lawsuit.

The Public Citizen lawyer, representing Yelp, stated that there is no justification for revealing the user’s identity, especially since The Rhodes Group did not file any complaint until well over a year after the review had been posted. According to its website, “Public Citizen maintains that the Rhodes Group’s claim violates the one-year statute of limitation for libel suits and, additionally, that the subpoena was issued in the wrong state and therefore cannot be enforced by the Texas court.” The Rhodes Group is fighting back stating, “You can’t use the First Amendment as a shield to make false and defamatory statements about an individual, particularly in a commercial arena.”

The Rhodes Group is absolutely right that Yelp cannot hide behind the “First Amendment Shield,” however, Yelp and Public Citizen are correct that the user’s identity should remain anonymous and there is no justification to reveal it. Bad, anonymous reviews, whether they are fake or genuine, are part of the online world. Millions of users have the ability to hide behind a keyboard and this allows us to bestow harsher criticism without fear of consequences. Freedom of speech does not include libel. Therefore, the result of this court case could determine how “free” freedom of speech actually is on the World Wide Web.

Jen is a business administration major with a concentration in management at Montclair State University, Class of 2017.

Toshiba’s Accounting Scandal

Posted by Bridget Uribe.

During the summer of 2015, one of the world’s most known Japanese companies broke headlines as a top accounting scandal. Investigators found the company was overstating operating profits by at least 151.8 billion yen ($1.2 billion in U.S. dollars) between the years of 2008 and 2014. Their accounting problems primarily began from company employees understating costs on long-term projects, according to an investigation by a former top prosecutor in Japan.

The investigation also cited issues with improperly valued inventory also as the cause for the enormous overstatement of operating profits. Details of the scandal emerged when an independent investigative panel released a report describing, “Toshiba CEOs put intense pressure on subordinates to meet sales targets after the 2008 global recession.” The investigative report revealed that the CEOs did not directly instruct anyone to cook the books but rather placed immense pressure on subordinates and waited for the corporate culture to turn out the results they wanted. The investigative panel also pointed out that the weak corporate governance and a poorly functioning system of internal controls at every level of the Toshiba conglomerate didn’t mitigate or stop the inappropriate behaviors. Internal controls in the finance division, the corporate auditing division, the risk management division, and in the securities disclosure committee were not functioning properly. The accounting misconduct began under CEO Atsutoshi Nishida in 2008 due to the global financial crisis that immensely lowered Toshiba’s profitability. It continued unabated under the next CEO, Norio Sasaki, and eventually ended in scandal under Tanaka. Toshiba CEO Hisao Tanaka announced his resignation, in light of the scandal.

It has been four months since the scandal broke headlines and much new information has come to light. Since then, Toshiba has amended and restated those losses as to being more than $1.9 billion. As a consequence of the scandal, the Tokyo Stock Exchange has already designated Toshiba’s shares as “securities on alert” and fined the company $760,000 for “undermining the confidence of shareholders and investors.” In addition, Toshiba also faces the possibility of lawsuits from angry shareholders in Japan who have seen the company’s share price tumble.

Such action is already being taken in the United States, where an investor has filed a class-action lawsuit against Toshiba in June. The Rosen Law Firm representing the plaintiff has called for other Toshiba shareholders to join the suit. Despite the consequences Toshiba is facing, the one burning question has yet to be solved. Who did this? How did all this came about? How could their fraud be maintained for so long, and who should take direct responsibility?

Bridget is a graduate forensic accounting student at the Feliciano School of Business, Montclair State University, Class of 2016.

The Fall of a Coal “Kingpin”

Posted by Dan Udvari.

On December 3, 2015 Donald L. Blankenship – the CEO of Massey Energy, Co. – was convicted of a single misdemeanor for conducting a conspiracy to violate safety rules in his coal mines just before the Upper Big Branch Mine disaster that occurred on April 5, 2010.

Massey Energy was the fourth largest publicly traded coal extractor by revenue ($2.69 billion) in the United States. It was founded in 1920 by the Massey family and operated in Richmond, Virginia. The company consisted of approximately 5800 employees right before Alpha Natural Resources acquired the company for 7.1 billion dollars. Interestingly, 99% of the shareholders voted in favor of the acquisition, which shows how poorly the company was governed by management. Don Blankenship took control over the company in 1992 and created a culture that favored profits over safety. In total, the coal extractor giant had around 369 citations and orders, which totaled a staggering 10.8 million dollars.

On April 5, 2015 a massive explosion in the Upper Big Branch Mine in Montcoal, West Virginia occurred that killed 29 people. This tragedy was the worst since the 1970 Hyden disaster. Massey Energy operated the Upper Big Branch Mine and later turned out that they operated the mine in a manner that was against several rules set up by the MSHA. The investigation later determined that the ventilation system in the mine did not work properly and failed to get rid of the toxic gases that caused the explosion. Massey intentionally neglected all the safety rules and citations issued by the MSHA for the purpose of increasing profits. However, this case goes deeper than one thinks. According to reports, Massey Energy is very influential on political figures and officials in West Virginia. Using this power, they were able to bribe and manipulate MSHA regulators so they look the other way when inspecting the mines.

In November 2014, Don Blankenship, was indicted by a federal jury on four criminal counts including conspiracy to violate safety laws, securities fraud, defrauding the federal government, and making false statements to the SEC. Even though he was charged with these, he was only found guilty of one on December 3, 2015. Had he been convicted of all four, he could have been sent to prison for approximately thirty years. Now, he is only serving one year in jail.

I do not believe that Blankenship should only serve one year in jail. It seems unfair to those who had lost their lives because of profits. It baffles me that people as greedy as him get away with conspiracy and murder charges. It seems that money can literally buy your freedom in the United States. All you need is a good lawyer or lawyers.

Dan is a graduate accounting student with a certificate in forensic accounting at the Feliciano School of Business, Montclair State University, Class of 2016.

Martin Shkreli Arrested on Fraud Charges

Posted by Katie Kim.

On Thursday, Martin Shkreli, a 32 year-old pharmaceutical executive, was arrested by the federal authorities on securities and wire-fraud charges stemming from an alleged Ponzi scheme he ran as a hedge-fund manager. What the young executive was doing was taking out loans from investors to start a new pharmaceutical company and using that money to pay off his debt from his hedge-fund. Martin Shkreli committed “fraud in nearly every aspect of hedge-fund investments and in connection with his stewardship of a public company,” said the director of enforcement at the Securities and Exchange Commission, Andrew J. Ceresney.

Shkreli was already notorious for price-gouging during his time at Turning Pharmaceuticals. His idea was to acquire decades old drugs and raise the price of it to $750 from $13.50 per pill. The current charges are not related to Shkreli’s work as chief executive of Turing Pharmaceuticals.

The federal authorities say that Shkreli was running three schemes that had connections to one another, he defrauded investors and used stock and cash from an unrelated pharmaceutical company to cover up the money he lost. The Brooklyn US attorney filed a seven-count criminal indictment and the Securities and Exchange Commission filed a related civil complaint on alleged securities fraud against Shkreli. Federal officials painted Mr. Shkreli’s business dealings as “a securities fraud trifecta of lies, deceit and greed.”

Shkreli was released on a $5 million bail, secured by a bank account and his father and brother. The authorities also arrested Evan L. Greebel who served as an outside counsel to Retrophin, the company Shkreli previously worked for. Shkreli treated Retrophin like his “personal piggy bank” where he used $11 million to pay back shareholders of MSMB funds.

Katie is an accounting/finance major at the Stillman School of Business, Seton Hall University, Class of 2018.

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

Farmers Suing Syngenta

Posted by Melissa Nomani.

Farmers across the United States are filing suits against Syngenta. As stated in the article, “The lawsuits allege the biotechnology company’s genetically modified Agrisure Viptera and Duracade seeds contaminated US corn shipments, making them unacceptable for export to China.” China does not allow the importation of GMO products that it has not tested. In February of 2014, China learned that the corn shipments from the U.S. contained Viptera. Agrisure Viptera is a seed that is genetically modified (known as MIR162) to prevent damage to crops by earworms and cutworms. As a result, China has rejected corn imports from the U.S.

Over 1,800 suits have been filed. Lawsuits filed against Syngenta state that the company put seeds on the market even though there was no approval from foreign markets. This has led to some farms having great financial losses. Even farmers who do not use GMO seeds could be affected due to accidental contamination from other fields. Syngenta has tried to refute the lawsuits by stating that they are not responsible for protecting farmers from GMO seeds. This arguments were rejected in September by Judge Lungstrum, who refused to dismiss the suits.

It has been estimated by The National Grain and Feed Association that as of April 2014 almost $3.0 billion worth of losses were caused by Syngenta’s Agrisure Viptera MIT162 corn seed.

The first of the lawsuits are expected to go to trial in June 2017.

Melissa is a finance major at the Stillman School of Business, Seton Hall University, Class of 2018.

Lumber Liquidators Sued for Defective Flooring from China

Posted by Melissa Nomani.

Lawsuits filed against Lumber Liquidators claim that homeowners who put certain laminate flooring into their home are being exposed to high levels of formaldehyde. This puts them at risk and also lowers the value of their property. As of this July, the number of lawsuits filed against the company has gone up from only a mere ten in June. Many lawsuits began being filed after a 60 Minutes episode that aired on March 1, 2015, exposing the high levels of formaldehyde in laminated flooring made in China. Formaldehyde is a known carcinogen and has been linked to cancer and respiratory problems. A study done by 60 Minutes showed that 30 out of 31 of the tested flooring samples (all of the sample were Lumber Liquidators products).

According to a study conducted by 60 Minutes, 30 of 31 flooring samples from Lumber Liquidators did not meet formaldehyde emissions standards. It is estimated that thousands of people have Lumber Liquidators flooring in their homes. Some lawsuits claim that homeowners have suffered from respiratory problems after installing the laminate flooring.

Another issue that has risen is that Lumber Liquidators is being accused of false advertising and selling products comprised of particles that come from endangered habitats and trees. The US Department of Justice is investigating the company for their alleged use of wood. The wood was illegally cut down from Russia–this directly violates the Lacey Act. The Lacey Act does not allow for the importation of products made from woods that are illegally logged.

Furthermore, this past May, Lumber Liquidators CEO, Robert Lynch, resigned. During this month the company also announced that it would be suspending the sale of flooring from China. The company offered homeowners free  indoor air quality screening, if they had purchased laminate flooring from China.

The number of lawsuits against Lumber Liquidators continues to grow.

Melissa is a finance major at the Stillman School of Business, Seton Hall University, Class of 2018.

Tax Avoidance, Tax Fraud, and Tax Evasion

Posted by Issam Abualnadi.

Tax is a sum of money levied on incomes, property, sales, etc., by a government for its support or for specific services. (The American Heritage Dictionary). According to the IRS website, the origin of the income tax on individuals is generally cited as the passage of the 16th Amendment, passed by Congress on July 2, 1909, and ratified February 3, 1913; however, history, it actually goes back even further. During the Civil, War Congress passed the Revenue Act of 1861, which included a tax on personal incomes to help pay war expenses. The tax was repealed ten years later. In 1894, however, Congress enacted a flat rate Federal income tax, which was ruled unconstitutional the following year by the U.S. Supreme Court. The Court held it was a direct tax not apportioned according to the population of each state.

The 16th amendment, ratified in 1913, removed this objection by allowing the Federal government to tax the income of individuals without regard to the population of each State. (IRS Website). The sole purpose of income tax is based economics and social goals.( Income Tax Fundamentals 1-2). While the government tries to maximize its revenue, at the same time, Congress tries to make the tax law suitable and fair for each individual. Therefore, the tax law not only divides the taxpayers into categories upon their income, but also it allows them to minimize their taxes due by structuring their tax return in different methods. Unfortunately, not every citizen is law-abiding in this respect, and accordingly, some taxpayers break the tax law. In the foregoing, I will discuss the differences between tax avoidance, tax fraud, and tax evasion.    Avoidance of tax is not a criminal offense. According to the IRS, taxpayers have the right to reduce, avoid, or minimize their taxes by legitimate means. One who avoids tax does not conceal or misrepresent, but shapes and preplans events to reduce or eliminate tax liability within the parameters of the law. Take for example, Warren Buffett. Buffett wrote in The New York Times in 2011 “ Last year my federal tax bill — the income tax I paid, as well as payroll taxes paid by me and on my behalf — was $6,938,744. That sounds like a lot of money. But what I paid was only 17.4 percent of my taxable income — and that’s actually a lower percentage than was paid by any of the other 20 people in our office. Their tax burdens ranged from 33 percent to 41 percent and averaged 36 percent” ( The New York Times). But how Buffett can do that?

Buffett and many other super rich people use different tax rules to avoid paying taxes, like the “cash-rich split-off.” This code mechanism is used when Company (A) puts cash or other “investment assets” plus a business into a subsidiary that it then swaps tax-free to Company (B) in return for B’s holding of A’s stock. In 2010 Graham Holdings and Berkshire (Warren Buffett’s corporation), saved a total of about $675 million in federal and state income taxes by going the “cash-rich split-off” route. Graham Holdings is trading cash, Berkshire stock that it owns, and a TV station for most of Berkshire’s 23 percent stake in Graham Holdings. Tax avoidance matches the well-known saying, “Work smarter not harder.” Also, it is worth mentioning that massive tax avoidance draws attention to the notion of the efficiency of the tax codes, and the need to produce new rules or restrictions prevent such legal tax evasion. (The New York Times).

Tax fraud is another way some taxpayers use to minimize their tax liability. According to the IRS website, tax fraud “is deception by misrepresentation of material facts, or silence when good faith requires expression, which results in material damage to one who relies on it and has the right to rely on it. Simply stated, it is obtaining something of value from someone else through deceit.” (IRS Section 25.1.1.2). According to IRS’s definition of tax fraud, not all the mistakes in preparing a tax return are considered a fraud, and in order to consider a case as a fraud, two elements should be presented:

  1. An additional tax due and owing as the result of a deliberate intent to evade tax; or

  2. The willful and material submission of false statements or false documents in connection with an application and/or return. (IRS Section 25.1.1.1). Generally the expression “Tax Fraud” used for civil and criminal cases.

The third area is tax evasion. Tax evasion, “Involves some affirmative act to evade or defeat a tax, or payment of tax. Examples of affirmative acts are deceit, subterfuge, camouflage, concealment, attempts to color or obscure events, or make things seem other than they are” (IRS Section 25.1.1.2.4). “It is typically used in the criminal context, and it is a subset of the tax fraud.”

Tax fraud and tax evasion are very close in their meaning; both are illegal way to reduce the tax liability. The IRS indicates tax fraud by two major indicators. The first indicator is when the taxpayer knowingly understates their tax liability often leaving evidence in the form of identifying earmarks. The second indicator is that serve as a sign or symptom, or signify that actions may have been done for the purpose of deceit, concealment or to make things seem other than what they are. Usually the IRS cannot prove that to court, because taxpayer can easily claim a good faith misunderstanding of the law or good faith belief that one is not violating the law negating willfulness. Therefore, the IRS chooses to prosecute the taxpayer civilly for underpaying taxes. In such cases, the IRS can impose a tax fraud penalty, which is 75% of the tax owed plus the interest on this penalty. On the other hand, tax evasion is a subset of tax fraud. In tax evasion cases, the very difficult burden for the IRS is to prove the willfulness, which means a voluntary, intentional violation of a known legal duty. (IRS, Section 25.1.1.1) To prove fraud, they must show the court that the taxpayer did the act deliberately for the purpose of deceit. Examples include omissions of specific items where similar items are included; concealment of bank accounts or other assets. (ISR Section 25.1.1.3). So if the IRS can prove that, then it is a tax evasion case. In tax evasion cases, the penalty range is up to five years in jail plus a big fine and plus the costs of prosecution for each separate tax crime.

In conclusion, the tax law was created to enable the government to support the economical and social activities in the American society. The lawmaker enacted some tax codes to help eligible taxpayers reduce their tax liability under exact conditions, but some still try to deceive the government by using illegal means.

Issam is an accounting major at the Feliciano School of Business, Montclair State University, Class of 2017.

Works Cited

“Sixteenth Amendment.” West’s Encyclopedia of American Law, edition 2. 2008. The Gale Group 17 Nov. 2014. http://legal-dictionary.thefreedictionary.com/Sixteenth+Amendment

tax.” The American Heritage® Dictionary of the English Language, Fourth Edition. 2003. Houghton Mifflin Company 23 Nov. 2014 http://www.thefreedictionary.com/tax

“Brief History of IRS.” Brief History of IRS. Web. 10 Oct. 2014. .

Whittenburg, Gerald E., and Ray Whittington. “The Individual Income Tax Return.” Income Tax Fundamentals. 2014 ed. St. Paul: Cengage Learning, 2014. 1-2. Print.

“Internal Revenue Manual – 25.1.1 Overview/Definitions.” Internal Revenue Manual – 25.1.1 Overview/Definitions. Web. 23 Nov. 2014. .

BUFFETT, WARREN. “Stop Coddling the Super-Rich.” The New York Times 14 Aug. 2011. Web.

IRS Fraud Scam Bilks People For More Than $23 Million

Online fraud is alive and well. About 4,550 people have been scammed by foreigners posing as IRS personnel and telling them they are about to be sued for unpaid taxes. The Treasury Inspector General, J. Russell George indicated they are working on bringing to justice the perpetrators of “‘the largest of its kind’” scam, yet taxpayers are urged to remain on “‘high alert.’”

According to George, a scammer will call an unsuspecting individual, claiming to be from the IRS. The “scammer tells the person that they have unpaid taxes and threatens him or her with a criminal violation, immediate arrest, deportation or loss of a business or driver’s license unless they settle the fees via a debit card or a wire transfer.” People have a hard time telling whether the call is legitimate because the scammers either use a robocall machine that leaves a message stating it is the IRS and they are being sued, or callers giving the last four digits of the victim’s social security number, or fake emails appearing to come from the IRS.

One of the ringleaders officials caught, Sahil Patel, is serving a 14 year sentence in federal prison for organizing call centers based in India, as part of the U.S. side of the scam.

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