The company you keep: spreading effects of financial fraud on investor trust.

PubMed

Bernet, Patrick Michael; Getzen, Thomas E

2007-01-01

Investor trust is valuable to health care organizations. Without it, they may face higher capital costs. This study explores recent cases of fraud and the appearance of impropriety by health care organizations, focusing on the manners in which trust was violated, the systems that allowed those violations, and the effects on financial markets. Increases in the incidence and scale of such transgressions may be harbingers of worse times ahead. This article examines how recent events have affected the cost of capital, and what health care organizations can do to avoid being judged by the company they keep.

[Fraud in the health-care system from the perspective of the public health insurance companies. Empirical findings on the work of anti-fraud agencies].

PubMed

Meier, B D; Homann, D

2010-07-01

The article summarises the results of a study on the activities of the German public health insurance companies to fight fraudulent behaviour in the system. The study is based on the analysis of 140 activity reports of the years 2004 and 2005 which the companies had to deliver to the Federal Social Insurance Authority as well as on the results of an additional survey. The article deals with the number of cases, the phenomenology of the delinquent acts, the referral of the suspicious cases to the law enforcement agencies, and the cooperation with other insurance companies. Finally, the article presents some considerations on an improved prevention of fraud in the public health care system. Copyright Georg Thieme Verlag KG Stuttgart . New York.

Medicare, Medicaid fraud a billion-dollar art form in the US

PubMed Central

Korcok, M

1997-01-01

Medicare and Medicaid fraud costs billions of dollars each year in the US. Investigators have shown that fraud is found in all segments of the health care system. Even though the Canadian system has stricter regulations and tighter controls, can regulators here afford to be complacent about believing that such abuse would not happen here? One province has established an antifraud unit to monitor its health insurance scheme; it already has 1 prosecution under its belt. PMID:9141996

78 FR 46339 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

...-crm-510.html . \\10\\ Department of Justice, ``Owners of Miami Home Health Companies Sentenced to Prison in $48 million Health Care Fraud Scheme.'' See http://www.justice.gov/opa/pr/2013/February/13-crm-243... Convicted in Medicare Fraud Scheme.'' See http://www.justice.gov/opa/pr/2013/March/13-crm-273.html . \\24...

Health Care Fraud: Characteristics, Sanctions, and Prevention. Briefing Report to the Honorable William V. Roth, Jr., U.S. Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Accounting and Financial Management Div.

At the request of Senator William Roth, Jr., the General Accounting Office (GAO) reviewed Medicare and Medicaid fraud investigations that agency inspectors general referred to the Department of Justice for prosecution to identify characteristics of alleged fraud against the government and to determine actions taken against those caught defrauding…

Expanding physician education in health care fraud and program integrity.

PubMed

Agrawal, Shantanu; Tarzy, Bruce; Hunt, Lauren; Taitsman, Julie; Budetti, Peter

2013-08-01

Program integrity (PI) spans the entire spectrum of improper payments from fraud to abuse, errors, and waste in the health care system. Few physicians will perpetrate fraud or abuse during their careers, but nearly all will contribute to the remaining spectrum of improper payments, making preventive education in this area vital. Despite the enormous impact that PI issues have on government-sponsored and private insurance programs, physicians receive little formal education in this area. Physicians' lack of awareness of PI issues not only makes them more likely to submit inappropriate claims, generate orders that other providers and suppliers will use to submit inappropriate claims, and document improperly in the medical record but also more likely to become victims of fraud schemes themselves.In this article, the authors provide an overview of the current state of PI issues in general, and fraud in particular, as well as a description of the state of formal education for practicing physicians, residents, and fellows. Building on the lessons from pilot programs conducted by the Centers for Medicare and Medicaid Services and partner organizations, the authors then propose a model PI education curriculum to be implemented nationwide for physicians at all levels. They recommend that various stakeholder organizations take part in the development and implementation process to ensure that all perspectives are included. Educating physicians is an essential step in establishing a broader culture of compliance and improved integrity in the health care system, extending beyond Medicare and Medicaid.

Recent developments in false claims enforcement: a minefield for health care providers.

PubMed

Whitaker, Glenn V; Walton, Victor A

2007-01-01

Actions under the False Claims Act represent potentially billions of dollars in damages returned to the state and federal governments each year for fraud recovery. Over the past several years, health care providers have been the target of about half of the FCA suits filed and have paid out an even greater percentage of the damages recovered. Because of the enumerable opportunities for fraud, waste, and abuse in the health care industry, it will likely continue to be a prominent target of FCA suits. Key provisions of the Deficit Reduction Act of 2005, effective on January 1, 2007, will only increase the reach of the FCA. Providers beware.

78 FR 47322 - Privacy Act of 1974; Report of an Altered System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

... reports for all health care practitioners (e.g., physicians, dentists, nurses, optometrists, pharmacists... appropriate decisions in the delivery of health care. 6. To state Medicaid Fraud Control Units that request... Information on Physicians and other Health Care Practitioners (NPDB), 09-15-0054, to include information...

78 FR 79201 - Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... interoperable electronic health records software or information technology and training services. The final rule... information technology and training services necessary and used predominantly to create, maintain, transmit... ordering of, any good, facility, service, or item reimbursable by any Federal health care program. Because...

The Stark truth: what your physician clients should know about Stark Law and the Anti-Kickback Statute.

PubMed

Taormina, Melissa

2013-01-01

This article summarizes key features of Stark Law and the Anti-Kickback Statute, statutes used to fight health care fraud and abuse within Medicare and Medicaid, and explains how attorneys can help health care providers comply with these laws.

Five Years of HHS Home Health Care Evaluations: Using Evaluation to Change National Policy

ERIC Educational Resources Information Center

Brandon, Paul R.; Smith, Nick L.; Grob, George F.

2012-01-01

In 1997, American Evaluation Association member George Grob, now retired from the U.S. Department of Health and Human Services (HHS) and currently President of the Center for Public Program Evaluation, made a testimony on Medicare home health care fraud and abuse before the U.S. Senate Special Committee on Aging. The occasion was to announce the…

Whistleblowing in the pharmaceutical industry in the United States, England, Canada, and Australia.

PubMed

Boumil, Sylvester James; Nariani, Ashiyana; Boumil, Marcia M; Berman, Harris A

2010-04-01

Fraud and abuse in the spending of public monies plague governments around the world. In the United States the False Claims Act encourages whistleblowing by private individuals to expose evidence of fraud. They are rewarded for their efforts with monetary compensation and protection from retaliation. Such is not the case in Canada, England, and Australia. Although some recent legislation has increased the protections afforded to whistleblowers, they are still likely to be viewed more as disloyal employees than courageous public servants, and there is little incentive to risk their jobs and reputation. Qui tam laws provide a police force of thousands in the effort to reduce rampant fraud, waste, and abuse, and would be an asset in any health-care system where pubic health policy requires conservation of resources.

42 CFR 1007.13 - Staffing requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Staffing requirements. 1007.13 Section 1007.13 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.13 Staffing requirements. (a) The unit will employ...

A prescription fraud detection model.

PubMed

Aral, Karca Duru; Güvenir, Halil Altay; Sabuncuoğlu, Ihsan; Akar, Ahmet Ruchan

2012-04-01

Prescription fraud is a main problem that causes substantial monetary loss in health care systems. We aimed to develop a model for detecting cases of prescription fraud and test it on real world data from a large multi-center medical prescription database. Conventionally, prescription fraud detection is conducted on random samples by human experts. However, the samples might be misleading and manual detection is costly. We propose a novel distance based on data-mining approach for assessing the fraudulent risk of prescriptions regarding cross-features. Final tests have been conducted on adult cardiac surgery database. The results obtained from experiments reveal that the proposed model works considerably well with a true positive rate of 77.4% and a false positive rate of 6% for the fraudulent medical prescriptions. The proposed model has the potential advantages including on-line risk prediction for prescription fraud, off-line analysis of high-risk prescriptions by human experts, and self-learning ability by regular updates of the integrative data sets. We conclude that incorporating such a system in health authorities, social security agencies and insurance companies would improve efficiency of internal review to ensure compliance with the law, and radically decrease human-expert auditing costs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

42 CFR 1007.7 - Organization and location requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Organization and location requirements. 1007.7 Section 1007.7 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.7 Organization and location requirements...

42 CFR 1007.17 - Annual report.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Annual report. 1007.17 Section 1007.17 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.17 Annual report. At least 60 days prior to the expiration of...

42 CFR 1007.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Definitions. 1007.1 Section 1007.1 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.1 Definitions. As used in this part, unless otherwise indicated by the...

78 FR 21314 - Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

... health records software or information technology and training services. The final rule for this safe... health records software or information technology and training services. In the same issue of the Federal..., licenses, and intellectual property related to electronic health records software; connectivity services...

78 FR 9393 - Delegation of Authorities

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-08

... under Section 1128C(a)(2) of the Social Security Act (the Act) (42 U.S.C. 1320a-7c(a)(2)), as amended... to the Health Care Fraud and Abuse Control Program created by Section 201(a) of the Health Insurance...

Corporate compliance: critical to organizational success.

PubMed

Cantone, L

1999-01-01

Operation Restore Trust (ORT) has focused increased governmental attention on health care fraud and abuse activities, making it more costly to be noncompliant, and thus has led to significant behavioral changes within the health care industry. Initially five states (California, Florida, Illinois, New York, & Texas) were included in the 1997 ORT pilot program. This has been expanded to include Arizona, Colorado, Georgia, Louisiana, Massachusetts, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, Virginia, and Washington. The author presents a road map for developing of a compliance program that includes suggested strategies for staff training in anticipation of heightened scrutiny of compliance standards and procedures. Effective Corporate Compliance Programs (CCPs) should include policies and procedures and monitoring systems that can provide reasonable assurance that fraud, abuse, and systematic billing errors are detected in a timely manner.

42 CFR 1007.11 - Duties and responsibilities of the unit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Duties and responsibilities of the unit. 1007.11 Section 1007.11 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.11 Duties and responsibilities of the...

42 CFR 1007.9 - Relationship to, and agreement with, the Medicaid agency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Relationship to, and agreement with, the Medicaid agency. 1007.9 Section 1007.9 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.9 Relationship to, and...

Who Can You Trust? Protecting Your Organization from Internal Fraud.

ERIC Educational Resources Information Center

Lukaszewski, Thomas E.

1997-01-01

Discusses how to protect a child care organization from employee fraud. Differentiates employee and management fraud and examines reasons fraud is committed. Suggests procedures for protecting an organization from fraud, including establishing an effective internal control system, paying attention to unusual employee behavior, reviewing expense…

Health Fraud

MedlinePlus

Health fraud involves selling drugs, devices, foods, or cosmetics that have not been proven effective. Keep in ... you from getting the treatment you really need. Health fraud scams can be found everywhere, promising help ...

Security systems engineering overview

DOE Office of Scientific and Technical Information (OSTI.GOV)

Steele, B.J.

Crime prevention is on the minds of most people today. The concern for public safety and the theft of valuable assets are being discussed at all levels of government and throughout the public sector. There is a growing demand for security systems that can adequately safeguard people and valuable assets against the sophistication of those criminals or adversaries who pose a threat. The crime in this country has been estimated at $70 billion in direct costs and up to $300 billion in indirect costs. Health insurance fraud alone is estimated to cost American businesses $100 billion. Theft, warranty fraud, andmore » counterfeiting of computer hardware totaled $3 billion in 1994. A threat analysis is a prerequisite to any security system design to assess the vulnerabilities with respect to the anticipated threat. Having established a comprehensive definition of the threat, crime prevention, detection, and threat assessment technologies can be used to address these criminal activities. This talk will outline the process used to design a security system regardless of the level of security. This methodology has been applied to many applications including: government high security facilities; residential and commercial intrusion detection and assessment; anti-counterfeiting/fraud detection technologies (counterfeit currency, cellular phone billing, credit card fraud, health care fraud, passport, green cards, and questionable documents); industrial espionage detection and prevention (intellectual property, computer chips, etc.); and security barrier technology (creation of delay such as gates, vaults, etc.).« less

Prevalence of Financial Fraud and Scams Among Older Adults in the United States: A Systematic Review and Meta-Analysis.

PubMed

Burnes, David; Henderson, Charles R; Sheppard, Christine; Zhao, Rebecca; Pillemer, Karl; Lachs, Mark S

2017-08-01

The financial exploitation of older adults was recently recognized by the Centers for Disease Control and Prevention as a serious public health problem. Knowledge of the prevalence of elder financial exploitation is mostly limited to the category of financial abuse, which occurs in relationships involving an expectation of trust. Little is known about the other major category of elder financial exploitation-elder financial fraud and scams, which is perpetrated by strangers. A valid estimate of elder financial fraud-scam prevalence is necessary as a foundation for research and prevention efforts. To estimate the prevalence of elder financial fraud-scam victimization in the United States based on a systematic review and meta-analysis. Multiple investigators independently screened titles and abstracts and reviewed relevant full-text records from PubMed, Medline, PsycINFO, Criminal Justice Abstracts, Social Work Abstracts, and AgeLine databases. To maximize the validity and generalizability of prevalence estimation, we restricted eligibility to general population-based studies (English speaking, 1990 onward) using state- or national-level probability sampling and collecting data directly from older adults. Information on elder financial fraud-scam prevalence and study-level characteristics was extracted independently by 2 investigators. Meta-analysis of elder financial fraud-scam prevalence used generalized mixed models with individual studies as levels of a random classification factor. We included 12 studies involving a total of 41 711 individuals in the meta-analysis. Overall pooled elder financial fraud-scam prevalence (up to 5-year period) across studies was 5.6% (95% confidence interval [CI] = 4.0%, 7.8%), with a 1-year period prevalence of 5.4% (95% CI = 3.2%, 7.6%). Studies using a series of questions describing specific fraud-scam events to measure victimization found a significantly higher prevalence (7.1%; 95% CI = 4.8%, 9.4%) than studies using a single, general-question self-report assessment approach (3.6%; 95% CI = 1.8%, 5.4%). Elder financial fraud and scams is a common problem, affecting approximately 1 of every 18 cognitively intact, community-dwelling older adults each year; it requires further attention from researchers, clinicians, and policymakers. Elder financial fraud-scam prevalence findings in this study likely underestimate the true population prevalence. We provide methodological recommendations to limit older adult participation and reporting bias in future population-based research. Public Health Implications. Elder financial exploitation victimization is associated with mortality, hospitalization, and poor physical and mental health. Health care professionals working with older adults likely routinely encounter patients who are fraud-scam victims. Validation of instruments to screen for elder financial fraud and scams in clinical settings is an important area of future research. Without effective primary prevention strategies, the absolute scope of this problem will escalate with the growing population of older adults.

GAO audit not apt to find pervasive fraud in CARE Act.

PubMed

1999-12-24

After hearing a series of news reports suggesting financial improprieties in programs run by Ryan White CARE Act recipients, a General Accounting Office (GAO) review of the program was made. A preliminary GAO report found only a few cases of fraud in the administration of funding stemming from the CARE Act, but that the potential for fraud is very real because of the lack of safeguards. These findings are considered important since the House Commerce Committee is expected to conduct oversight hearings into further authorization of the CARE Act early in 2000.

Wayward Prescriptions: Costs of Fraud in Payor Plans

PubMed Central

Kaye, Thomas

2008-01-01

The cost of prescription drugs and medical devices has increased dramatically over the past several years. This increase has exceeded the annual average inflation index, making medical products desired sources of ill-gotten financial gains through diversion, theft, fraud, and deceit. With databases often being compromised, personal health information, personal identification, and therapy history are all available to be used by thieves through deception and misrepresentation, and are being traded on clandestine websites. With increasing values of medical services, wanted efforts continue to emerge in profiteering schemes, using illicit deals for financial gains by exploiting what was once perceived as sacred areas of medical care. Estimates of healthcare resource costs in dollars, lives, and products exceed $200 billion. Select examples of fraud in our medical services are presented that expose plan members to the risks of loss and theft that can compromise the privacy of their health records. The author outlines prevention steps for payors to guard against such practices. PMID:25126240

Child Care and Development Fund: Undercover Tests Show Five State Programs Are Vulnerable to Fraud and Abuse. Report to Congressional Addressees. GAO-10-1062

ERIC Educational Resources Information Center

Kutz, Gregory D.

2010-01-01

Through the Child Care and Development Fund (CCDF), the U.S. Department of Health and Human Services (HHS) subsidizes child care for low-income families whose parents work or attend education or training programs. In fiscal year 2009, the CCDF budget was $7 billion. States are responsible for determining program priorities and overseeing funds.…

The paper monster. Corporate compliance and the board.

PubMed

Hinrichsen, C A; Capobianco, C; Diamond, M

2001-02-01

Fraud and abuse lawsuits and settlements are getting bigger, and the DOJ shows no signs of letting up on its scrutiny of health care organizations. That's why a strong compliance program is your best defense, and it all starts with the board.

Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General's Exclusion Authorities. Final rule.

PubMed

2017-01-12

This final rule amends the regulations relating to exclusion authorities under the authority of the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS or the Department). The final rule incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions.

42 CFR 455.21 - Cooperation with State Medicaid fraud control units.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Cooperation with State Medicaid fraud control units. 455.21 Section 455.21 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud...

Detecting Health Fraud in the Field of Learning Disabilities.

ERIC Educational Resources Information Center

Worrall, Russell S.

1990-01-01

This article discusses health fraud in special education. Psychopathology of health fraud, standards by which pseudoscience and quackery are defined, and the complexities of learning disorders are considered. A scale to determine whether an alternative therapy is reasonable is presented. Several popular therapies are used as examples. (Author/PB)

The REIT stuff. Do real estate investment trusts have what it takes to bridge hospital compliance gaps?

PubMed

Haugh, R

1998-11-05

Up to now, real estate investment trusts have put most of their health care dollars into nursing homes. Thanks to federal fraud probes, some REIT executives see medical office buildings as their next big market.

Recovering fraudulent claims for Australian federal expenditure on pharmaceuticals and medical devices.

PubMed

Faunce, Thomas; Urbas, Gregor; Skillen, Lesley; Smith, Marc

2010-12-01

The Australian Federal Government expends increasingly large amounts of money on pharmaceuticals and medical devices. It is likely, given government experience in other jurisdictions, that a significant proportion of this expenditure is paid as a result of fraudulent claims presented by corporations. In the United States, legislation such as the False Claims Act 1986 (US), the Fraud Enforcement and Recovery Act 2009 (US), the Stark (Physician Self-Referral) Statute 1995 (US), the Anti-Kickback Statute 1972 (US), the Food, Drug and Cosmetic Act 1938 (US), the Social Security Act 1965 (US), and the Patient Protection and Affordable Care Act 2010 (US) has created systematic processes allowing the United States Federal Government to recover billions of dollars in fraudulently made claims in the health and procurement areas. The crucial component involves the creation of financial incentives for information about fraud to be revealed from within the corporate sector to the appropriate state officials. This article explores the opportunities for creating a similar system in Australia in the health care setting.

Cataract Surgery: Fraud, Waste, and Abuse. A Report by the Chairman of the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Aging.

This report is a summary of the findings from the Subcommittee on Health and Long-Term Care of the United States House of Representatives Select Committee on Aging investigation of cataract surgery and the use of intraocular lenses (IOL's) in the United States. The document provides background on the definition and treatment of cataracts and…

Eliminating waste in US health care.

PubMed

Berwick, Donald M; Hackbarth, Andrew D

2012-04-11

The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.

Interventional pain management at crossroads: the perfect storm brewing for a new decade of challenges.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Boswell, Mark V

2010-01-01

The health care industry in general and care of chronic pain in particular are described as recession-proof. However, a perfect storm with a confluence of many factors and events -none of which alone is particularly devastating - is brewing and may create a catastrophic force, even in a small specialty such as interventional pain management. Multiple challenges related to interventional pain management in the current decade will include individual and group physicians, office practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD). Rising health care costs are discussed on a daily basis in the United States. The critics have claimed that health outcomes are the same as or worse than those in other countries, but others have presented the evidence that the United States has the best health care system. All agree it is essential to reduce costs. Numerous factors contribute to increasing health care costs. They include administrative costs, waste, abuse, and fraud. It has been claimed the U.S. health care system wastes up to $800 billion a year. Of this, fraud accounts for approximately $200 billion a year, involving fraudulent Medicare claims, kickbacks for referrals for unnecessary services, and other scams. Administrative inefficiency and redundant paperwork accounts for 18% of health care waste, whereas medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total. Further, American physicians spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor, more than any other country. It has been illustrated that it takes $60,000 to $88,000 per physician per year, equal to one-third of a family practitioner's gross income, and $23 to $31 billion each year in total to interact with health insurance plans. The studies have illustrated that an average physician spends $68,274 per year communicating with insurance companies and performing other non-medical functions. For an office-based practice, the overall total in the United States is $38.7 billion, or $85,276 per physician. In the United States there are 2 types of physician payment systems: private health care and Medicare. Medicare has moved away from the Medicare Economic Index (MEI) and introduced the sustainable growth rate (SGR) formula which has led to cuts in physician payments on a yearly basis. In 2010 and beyond into the new decade, interventional pain management will see significant changes in how we practice medicine. There is focus on avoiding waste, abuse, fraud, and also cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have been introduced as cost-cutting and rationing measures, however, with biased approaches. This manuscript will analyze various issues related to interventional pain management with a critical analysis of physician payments, office facility payments, and ASC payments by various payor groups.

Responding to a crisis: a stakeholder analysis of community health organizations.

PubMed

Savage, Grant T; Dunkin, Jeri W; Ford, David M

2004-01-01

On May 11, 2001, the Bureau of Primary Health Care notified West Alabama Health Services, doing business as Family HealthCare of Alabama, that it was terminating $6 million in grants due to non-compliance and amid allegations of financial mismanagement and fraud. West Alabama Health Services, a not-for-profit organization, operated 19 community health centers that provided preventive and primary care services for 17 counties in Alabama. This disruption of health services engendered considerable stakeholder debate. Within this context, the authors examine how a small, newly established rural health center and a well-established, federally qualified community health center responded to this crisis. The authors use a stakeholder analysis framework to highlight how key relationships with stakeholders may change with the perceived credibility of the organizational leaders and the legitimacy of their actions.

Data Hemorrhages in the Health-Care Sector

NASA Astrophysics Data System (ADS)

Johnson, M. Eric

Confidential data hemorrhaging from health-care providers pose financial risks to firms and medical risks to patients. We examine the consequences of data hemorrhages including privacy violations, medical fraud, financial identity theft, and medical identity theft. We also examine the types and sources of data hemorrhages, focusing on inadvertent disclosures. Through an analysis of leaked files, we examine data hemorrhages stemming from inadvertent disclosures on internet-based file sharing networks. We characterize the security risk for a group of health-care organizations using a direct analysis of leaked files. These files contained highly sensitive medical and personal information that could be maliciously exploited by criminals seeking to commit medical and financial identity theft. We also present evidence of the threat by examining user-issued searches. Our analysis demonstrates both the substantial threat and vulnerability for the health-care sector and the unique complexity exhibited by the US health-care system.

77 FR 1555 - Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-10

... terminal, telephone, computer, or magnetic tape, for the purpose of ordering, instructing, or authorizing a... Disadvantages of EFT According to the 2010 AFP Electronic Payments: Report of Survey Results, produced by the... checks; Fraud control: The above-cited AFP survey found that 90 percent of organizations that experienced...

Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General's Civil Monetary Penalty Rules. Final rule.

PubMed

2016-12-07

This final rule amends the civil monetary penalty (CMP or penalty) rules of the Office of Inspector General to incorporate new CMP authorities, clarify existing authorities, and reorganize regulations on civil money penalties, assessments, and exclusions to improve readability and clarity.

42 CFR 455.23 - Suspension of payments in cases of fraud.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Suspension of payments in cases of fraud. 455.23... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and Investigation Program § 455.23 Suspension of payments in cases of fraud. (a) Basis for...

Home health, long-term care, and other compliance activities.

PubMed

Anderson, T D; Sadoff, J W

1999-04-01

The Federal government continues to crack down on fraud and abuse in the healthcare industry with such initiatives and tools as Operation Restore Trust and intermediate tax sanctions. Home health and long-term care organizations are the latest entities under study by the Office of Inspector General, and the result of these studies likely will be more antifraud and abuse measures being taken against these entities. All healthcare organizations should pay particular attention to their tax risk exposure. Healthcare organizations that put effective compliance programs in place should be able to reduce the overall risk of challenges to their financial practices.

Defining the public health threat of food fraud.

PubMed

Spink, John; Moyer, Douglas C

2011-01-01

Food fraud, including the more defined subcategory of economically motivated adulteration, is a food risk that is gaining recognition and concern. Regardless of the cause of the food risk, adulteration of food is both an industry and a government responsibility. Food safety, food fraud, and food defense incidents can create adulteration of food with public health threats. Food fraud is an intentional act for economic gain, whereas a food safety incident is an unintentional act with unintentional harm, and a food defense incident is an intentional act with intentional harm. Economically motivated adulteration may be just that-economically motivated-but the food-related public health risks are often more risky than traditional food safety threats because the contaminants are unconventional. Current intervention systems are not designed to look for a near infinite number of potential contaminants. The authors developed the core concepts reported here following comprehensive research of articles and reports, expert elicitation, and an extensive peer review. The intent of this research paper is to provide a base reference document for defining food fraud-it focuses specifically on the public health threat-and to facilitate a shift in focus from intervention to prevention. This will subsequently provide a framework for future quantitative or innovative research. The fraud opportunity is deconstructed using the criminology and behavioral science applications of the crime triangle and the chemistry of the crime. The research provides a food risk matrix and identifies food fraud incident types. This project provides a starting point for future food science, food safety, and food defense research. Food fraud, including the more defined subcategory of economically motivated adulteration, is a food protection threat that has not been defined or holistically addressed. The terrorist attacks of September 11, 2001, led to the development of food defense as an autonomous area of study and a new food protection discipline. As economically motivated adulteration grows in scope, scale, and awareness, it is conceivable that food fraud will achieve the same status as an autonomous concept, between food safety and food defense. This research establishes a starting point for defining food fraud and identifying the public health risks. © 2011 Institute of Food Technologists®

Food Assistance: Efforts To Control Fraud and Abuse in the Child and Adult Care Food Program Should Be Strengthened. United States General Accounting Office Report to Congressional Committees.

ERIC Educational Resources Information Center

Robertson, Robert E.

The Child and Adult Care Food Program provides over $1.5 billion in benefits annually to children and adults in day care. In order to address the longstanding problems of fraud and abuse present in the program, state agencies have been charged with the responsibility for implementing Food and Nutrition Service's (FNS) regulations to prevent and…

Evaluating motives: Two simple tests to identify and avoid entanglement in legally dubious urine drug testing schemes.

PubMed

Barnes, Michael C; Worthy, Stacey L

2015-01-01

This article educates healthcare practitioners on the legal framework prohibiting abusive practices in urine drug testing (UDT) in medical settings, discusses several profit-driven UDT schemes that have resulted in enforcement actions, and provides recommendations for best practices in UDT to comply with state and federal fraud and anti-kickback statutes. The authors carefully reviewed and analyzed statutes, regulations, adivsory opinions, case law, court documents, articles from legal journals, and news articles. Certain facts-driven UDT arrangements tend to violate federal and state healthcare laws and regulations, including Stark law, the anti-kickback statute, the criminal health care fraud statute, and the False Claims Act. Healthcare practitioners who use UDT can help ensure that they are in compliance with applicable federal and state laws by evaluating whether their actions are motivated by providing proper care to their patients rather than by profits. They must avoid schemes that violate the spirit of the law while appearing to comply with the letter of the law. Such a simple self-evaluation of motive can reduce a practitioner's likelihood of civil fines and criminal liability.

Financial viability, medical technology, and hospital closures.

PubMed

Prince, T R; Sullivan, J A

2000-01-01

Informed investments in medical technology and information systems are associated with the financial viability of community hospitals. Financially distressed facilities are 3 to 4 years behind proactive hospitals in supporting high-speed data, voice, and image transmissions to physicians in various locations. Impact of the Balanced Budget Act of 1997, fraud and abuse activities, Y2K issues, and lack of information systems support for physicians will result in 800 hospital closures and mergers of distressed hospitals over the next 60 months. These findings are based on the application of an eight-step framework for classifying information systems in health care entities. This framework is validated by survey instruments, site visits, interviews with senior management in 44 health care entities containing 576 hospitals, and judgments on the financial status of the health care entities.

Notes on a National Strategy for Global Education

DTIC Science & Technology

2011-12-01

6 U.S. Government Accountability Office, Foreign Languages: Human Capital Approach Needed to Correct Staffing and Proficiency Shortfalls, No...FBI reports that it has had difficulties building health- care fraud cases, convicting violent gang members, and analyzing audiotapes and written...5491–5494. 30 Formerly the General Accounting Office. 31 U.S. General Accounting Office. Foreign Languages: Human Capital Approach Needed to

Office of Inspector General; Medicare and state health care programs: fraud and abuse; issuance of advisory opinions by the OIG. Final rule.

PubMed

2008-07-17

OIG is adopting in final form, without change, an interim final rule published on March 26, 2008 (73 FR 15937). We received no comments to the interim final rule. The interim final rule revised the process for advisory opinion requestors to submit payments for advisory opinion costs.

Avoiding fraud risks associated with EHRs.

PubMed

Helton, Jeffrey R

2010-07-01

Fraud associated with electronic health records (EHRs) generally falls into two categories: inappropriate billing by healthcare providers and inappropriate access by a system's users. A provider's EHR system requires controls to be of any significant help in detecting such fraudulent activity, or in gathering transactional evidence should such activity be identified. To protect against potential EHR-related healthcare fraud, providers should follow the recommendations established in 2007 by RTI International for the Office of the National Coordinator for Health Information Technology of the U.S. Department of Health and Human Services.

Firm's health going south. Federal authorities charge HealthSouth, leader Scrushy with 'massive accounting fraud,' systematic betrayal of investors.

PubMed

Romano, Michael

2003-03-24

HealthSouth and its chief executive Richard Scrushy, left, find themselves coping with a public relations nightmare after federal officials last week charged the rehabilitation giant with "massive accounting fraud" and a systematic betrayal of tens of thousands of investors.

42 CFR 455.14 - Preliminary investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and Investigation Program § 455.14 Preliminary investigation. If the agency receives a complaint of Medicaid fraud...

42 CFR 455.21 - Cooperation with State Medicaid fraud control units.

Code of Federal Regulations, 2014 CFR

2014-10-01

... subchapter. In using this information, the unit must protect the privacy rights of beneficiaries; and (3) On... 42 Public Health 4 2014-10-01 2014-10-01 false Cooperation with State Medicaid fraud control units. 455.21 Section 455.21 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

20 CFR 410.699a - Penalties for fraud.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Penalties for fraud. 410.699a Section 410.699a Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969... Review, Finality of Decisions, and Representation of Parties § 410.699a Penalties for fraud. The penalty...

42 CFR 1001.951 - Fraud and kickbacks and other prohibited activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Fraud and kickbacks and other prohibited activities... Permissive Exclusions § 1001.951 Fraud and kickbacks and other prohibited activities. (a) Circumstance for..., or (B) Imposition of a civil money penalty against others; or (iii) Alternative sources of the type...

42 CFR 1001.951 - Fraud and kickbacks and other prohibited activities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Fraud and kickbacks and other prohibited activities... Permissive Exclusions § 1001.951 Fraud and kickbacks and other prohibited activities. (a) Circumstance for..., or (B) Imposition of a civil money penalty against others; or (iii) Alternative sources of the type...

45 CFR 149.41 - Consequences of Non-Compliance, Fraud, or Similar Fault.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Consequences of Non-Compliance, Fraud, or Similar Fault. 149.41 Section 149.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... Eligible Employment-Based Plans § 149.41 Consequences of Non-Compliance, Fraud, or Similar Fault. Upon...

Medicare and state health care programs: fraud and abuse; safe harbor for federally qualified health centers arrangements under the anti-kickback statute. Final rule.

PubMed

2007-10-04

In accordance with section 431 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), this final rule sets forth a safe harbor under the anti-kickback statute to protect certain arrangements involving goods, items, services, donations, and loans provided by individuals and entities to certain health centers funded under section 330 of the Public Health Service Act. The goods, items, services, donations, or loans must contribute to the health center's ability to maintain or increase the availability, or enhance the quality, of services available to a medically underserved population.

Introducing Food Fraud including translation and interpretation to Russian, Korean, and Chinese languages.

PubMed

Spink, John; Moyer, Douglas C; Park, Hyeonho; Wu, Yongning; Fersht, Victor; Shao, Bing; Hong, Miao; Paek, Seung Yeop; Edelev, Dmitry

2015-12-15

This paper introduces the topic of Food Fraud with translations to Russian, Korean, and Chinese. The concepts provide a system-wide focus leading to prevention. The goal is not to detect Food Fraud but to adjust entire food supply chains to reduce fraud opportunities. Food Fraud is a recently defined area of Food Protection between Food Safety (such as Salmonella or pesticide residue), and Food Defense (malicious intent to harm such as terrorism). Food Fraud is intentional with no intent to harm but only for economic gain. As with improving Food Safety and Food Defense, preventing Food Fraud is good for society and the economy. Society benefits through fewer public health threats from unauthorized acts. Society also benefits from increased consumer satisfaction and harmony. Food Security is increased through the production of more, higher-value products for consumers, commerce, and exporting. Food Fraud can reduce economic output because sickened citizens cannot work and it also reduces consumer confidence leading to less commerce. Copyright © 2014 Elsevier Ltd. All rights reserved.

45 CFR 30.3 - Antitrust, fraud, exception in the account of an accountable official, and interagency claims...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Antitrust, fraud, exception in the account of an accountable official, and interagency claims excluded. 30.3 Section 30.3 Public Welfare DEPARTMENT OF HEALTH... antitrust violations or fraud. (1) The standards in this part relating to compromise, suspension, and...

76 FR 21373 - Privacy Act of 1974; Report of a New System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... Information Security Management Act of 2002; the Computer Fraud and Abuse Act of 1986; the Health Insurance... 1974; the Federal Information Security Management Act of 2002; the Computer Fraud and Abuse Act of 1986... established by State law; (3) support litigation involving the Agency; (4) combat fraud, waste, and abuse in...

[Communication of scientific fraud].

PubMed

Zeitoun, Jean-David; Rouquette, Sébastien

2012-09-01

There is for a scientific journal several levels of communication depending of the degree of suspicion or certainty of a case of error or fraud. The task is increasingly difficult for journal editors as disclosed cases of fraud are more common and scientific communication on this topic is growing. Biomedical fraud is fairly little reported by the mainstream press and causes of this low interest are not currently well understood. The difficulty of processing this type of news for journalists appears to be one possible reason. The potentially numerous and significant consequences of fraud on health professionals are poorly documented. Though it is likely to cause a feeling of distrust and create controversy, the impact of fraud on the general public is poorly studied and appears multifactorial. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... laws and regulations designed to prevent fraud, waste, and abuse, including, but not limited to...

42 CFR 455.23 - Withholding of payments in cases of fraud or willful misrepresentation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... willful misrepresentation. 455.23 Section 455.23 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and Investigation Program § 455.23 Withholding of payments in cases of...

Is Psychological Vulnerability Related to the Experience of Fraud in Older Adults?

PubMed Central

LICHTENBERG, PETER A.; STICKNEY, LAURIE; PAULSON, DANIEL

2013-01-01

Financial exploitation, and particularly thefts and scams, are increasing at an alarming rate. In this study we (a) determined the national prevalence of older adults who report having been a victim of fraud, (b) created a population-based model for the prediction of fraud, and (c) examined how fraud is experienced by the most psychologically vulnerable older adults. The older adults studied were 4,400 participants in a Health and Retirement Study substudy, the 2008 Leave Behind Questionnaire. The prevalence of fraud across the previous 5 years was 4.5%. Among measures collected in 2002, age, education, and depression were significant predictors of fraud. Financial satisfaction and social-needs fulfillment were measured in 2008 and were significantly related to fraud above and beyond the 2002 predictors. Using depression and social-needs fulfillment to determine the most psychologically vulnerable older adults, we found that fraud prevalence was three times higher (14%) among those with the highest depression and the lowest social-needs fulfillment than among the rest of the sample (4.1%; χ2 = 20.49; p < .001). Clinical gerontologists and other professionals in the field need to be aware of their psychologically vulnerable clients heightened exposure to financial fraud. PMID:23997404

Elder Fraud and Financial Exploitation: Application of Routine Activity Theory.

PubMed

DeLiema, Marguerite

2017-03-10

Elder financial exploitation, committed by individuals in positions of trust, and elder fraud, committed by predatory strangers, are two forms of financial victimization that target vulnerable older adults. This study analyzes differences between fraud and financial exploitation victims and tests routine activity theory as a contextual model for victimization. Routine activity theory predicts that criminal opportunities arise when a motivated offender and suitable target meet in the absence of capable guardians. Fifty-three financial exploitation and fraud cases were sampled from an elder abuse forensic center. Data include law enforcement and caseworker investigation reports, victim medical records, perpetrator demographic information, and forensic assessments of victim health and cognitive functioning. Fraud and financial exploitation victims performed poorly on tests of cognitive functioning and financial decision making administered by a forensic neuropsychologist following the allegations. Based on retrospective record review, there were few significant differences in physical health and cognitive functioning at the time victims' assets were taken, although their social contexts were different. Significantly more fraud victims were childless compared with financial exploitation victims. Fraud perpetrators took advantage of elders when they had no trustworthy friends or relatives to safeguard their assets. Findings support an adapted routine activity theory as a contextual model for financial victimization. Fraud most often occurred when a vulnerable elder was solicited by a financial predator in the absence of capable guardians. Prevention efforts should focus on reducing social isolation to enhance protection. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Governmental efforts to improve quality of care for nursing home residents and to protect them from mistreatment: a survey of federal and state laws.

PubMed

Gittler, Josephine

2008-10-01

There are many federal and state laws addressing, directly and indirectly, the quality of care provided to nursing home residents and the protection of residents from mistreatment. They include: (a) state laws that govern the licensing of nursing homes, (b) federal laws that govern the certification of nursing homes for participation in the Medicare and Medicaid programs, (c) elder abuse laws prohibiting mistreatment of older adults in nursing homes and other settings, (d) health care fraud abuse laws that are increasingly being used to combat the provision of substandard care to Medicare and Medicaid beneficiaries in nursing homes, and (e) laws that have established long-term care ombudsman programs to promote the health, safety, well-being, and rights of nursing home residents. While these laws are generally viewed as having improved the care and treatment of nursing home residents, much remains to be done, particularly with respect to the implementation of these laws.

Podcast: Scientific Integrity and Lab Fraud

EPA Pesticide Factsheets

Nov 25, 2015. Dr. Bruce Woods, a chemist in the Electronic Crimes Division within the OIG’s Office of Investigations discusses his recent webinar for the Association of Public Health Laboratories on lab fraud.

Business knowledge in surgeons.

PubMed

Satiani, Bhagwan

2004-07-01

Surgeons and residents in training receive little, if any, formal education in the economic side of clinical practice during medical school or residency. As medical professionals face shrinking reimbursement, loss of control over health care decisions, and limited resources, surgical specialties must reevaluate the need to teach their members business survival skills. Before designing business related-teaching modules, educators must know the exact gaps in knowledge that exist among surgeons. This article reports a survey of 133 surgeons in the Midwest who were asked to rate their knowledge base in 11 business topics relevant to the practice of medicine. The survey showed that the average surgeon perceives himself or herself to be poorly equipped to understand basic financial accounting principles, financial markets, economics of health care, tools for evaluating purchases, marketing, budgets, antitrust and fraud and abuse regulations, and risk and return on investments. Armed with this data, teaching faculty, health care systems, and medical specialty societies should design business education seminars to better position surgical specialists and trainees to communicate with insurers, hospital administrators, health care organizations, and their own personal financial advisors.

Combating healthcare corruption and fraud with improved global health governance.

PubMed

Mackey, Tim K; Liang, Bryan A

2012-10-22

Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of "global health corruption" and development of a treaty protocol to combat this crucial issue.

The evaluation of trustworthiness to identify health insurance fraud in dentistry.

PubMed

Wang, Shu-Li; Pai, Hao-Ting; Wu, Mei-Fang; Wu, Fan; Li, Chen-Lin

2017-01-01

According to the investigations of the U.S. Government Accountability Office (GAO), health insurance fraud has caused an enormous pecuniary loss in the U.S. In Taiwan, in dentistry the problem is getting worse if dentists (authorized entities) file fraudulent claims. Several methods have been developed to solve health insurance fraud; however, these methods are like a rule-based mechanism. Without exploring the behavior patterns, these methods are time-consuming and ineffective; in addition, they are inadequate for managing the fraudulent dentists. Based on social network theory, we develop an evaluation approach to solve the problem of cross-dentist fraud. The trustworthiness score of a dentist is calculated based upon the amount and type of dental operations performed on the same patient and the same tooth by that dentist and other dentists. The simulation provides the following evidence. (1) This specific type of fraud can be identified effectively using our evaluation approach. (2) A retrospective study for the claims is also performed. (3) The proposed method is effective in identifying the fraudulent dentists. We provide a new direction for investigating the genuineness of claims data. If the insurer can detect fraudulent dentists using the traditional method and the proposed method simultaneously, the detection will be more transparent and ultimately reduce the losses caused by fraudulent claims. Copyright © 2016 Elsevier B.V. All rights reserved.

Fraud at the Global Fund? A viewpoint.

PubMed

Brown, Jonathan C; Griekspoor, Wilfred

2013-01-01

The Global Fund to Fight AIDS, Tuberculosis and Malaria has contributed to remarkable health improvements in the three diseases since its creation in 2002. However, media reports about "astonishing losses" and fraud in Fund programs in 2011 caused several donors to suspend funding. The Fund's annual round of new financing was canceled, and a substantial reform program is being implemented. Two former senior managers of the Fund contend that fraud was never a major problem; rather than imposing harsh new controls on recipient countries that might impede health outcomes, the Fund should maintain the core elements of its innovative model and make selective rather than sweeping changes in its operations. Copyright © 2012 John Wiley & Sons, Ltd.

Improving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study

PubMed Central

Joudaki, Hossein; Rashidian, Arash; Minaei-Bidgoli, Behrouz; Mahmoodi, Mahmood; Geraili, Bijan; Nasiri, Mahdi; Arab, Mohammad

2016-01-01

Background: We aimed to identify the indicators of healthcare fraud and abuse in general physicians’ drug prescription claims, and to identify a subset of general physicians that were more likely to have committed fraud and abuse. Methods: We applied data mining approach to a major health insurance organization dataset of private sector general physicians’ prescription claims. It involved 5 steps: clarifying the nature of the problem and objectives, data preparation, indicator identification and selection, cluster analysis to identify suspect physicians, and discriminant analysis to assess the validity of the clustering approach. Results: Thirteen indicators were developed in total. Over half of the general physicians (54%) were ‘suspects’ of conducting abusive behavior. The results also identified 2% of physicians as suspects of fraud. Discriminant analysis suggested that the indicators demonstrated adequate performance in the detection of physicians who were suspect of perpetrating fraud (98%) and abuse (85%) in a new sample of data. Conclusion: Our data mining approach will help health insurance organizations in low-and middle-income countries (LMICs) in streamlining auditing approaches towards the suspect groups rather than routine auditing of all physicians. PMID:26927587

Improving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study.

PubMed

Joudaki, Hossein; Rashidian, Arash; Minaei-Bidgoli, Behrouz; Mahmoodi, Mahmood; Geraili, Bijan; Nasiri, Mahdi; Arab, Mohammad

2015-11-10

We aimed to identify the indicators of healthcare fraud and abuse in general physicians' drug prescription claims, and to identify a subset of general physicians that were more likely to have committed fraud and abuse. We applied data mining approach to a major health insurance organization dataset of private sector general physicians' prescription claims. It involved 5 steps: clarifying the nature of the problem and objectives, data preparation, indicator identification and selection, cluster analysis to identify suspect physicians, and discriminant analysis to assess the validity of the clustering approach. Thirteen indicators were developed in total. Over half of the general physicians (54%) were 'suspects' of conducting abusive behavior. The results also identified 2% of physicians as suspects of fraud. Discriminant analysis suggested that the indicators demonstrated adequate performance in the detection of physicians who were suspect of perpetrating fraud (98%) and abuse (85%) in a new sample of data. Our data mining approach will help health insurance organizations in low-and middle-income countries (LMICs) in streamlining auditing approaches towards the suspect groups rather than routine auditing of all physicians. © 2016 by Kerman University of Medical Sciences.

Fraud in a population-based study of headache: prevention, detection and correction

PubMed Central

2014-01-01

Background In medicine, research misconduct is historically associated with laboratory or pharmaceutical research, but the vulnerability of epidemiological surveys should be recognized. As these surveys underpin health policy and allocation of limited resources, misreporting can have far-reaching implications. We report how fraud in a nationwide headache survey occurred and how it was discovered and rectified before it could cause harm. Methods The context was a door-to-door survey to estimate the prevalence and burden of headache disorders in Pakistan. Data were collected from all four provinces of Pakistan by non-medical interviewers and collated centrally. Measures to ensure data integrity were preventative, detective and corrective. We carefully selected and trained the interviewers, set rules of conduct and gave specific warnings regarding the consequences of falsification. We employed two-fold fraud detection methods: comparative data analysis, and face-to-face re-contact with randomly selected participants. When fabrication was detected, data shown to be unreliable were replaced by repeating the survey in new samples according to the original protocol. Results Comparative analysis of datasets from the regions revealed unfeasible prevalences and gender ratios in one (Multan). Data fabrication was suspected. During a surprise-visit to Multan, of a random sample of addresses selected for verification, all but one had been falsely reported. The data (from 840 cases) were discarded, and the survey repeated with new interviewers. The new sample of 800 cases was demographically and diagnostically consistent with other regions. Conclusion Fraud in community-based surveys is seldom reported, but no less likely to occur than in other fields of medical research. Measures should be put in place to prevent, detect and, where necessary, correct it. In this instance, had the data from Multan been pooled with those from other regions before analysis, a damaging fraud might have escaped notice. PMID:24916996

Medicare and state health care programs: fraud and abuse; electronic health records safe harbor under the anti-kickback statute. Final rule.

PubMed

2013-12-27

In this final rule, the Office of Inspector General (OIG) amends the safe harbor regulation concerning electronic health records items and services, which defines certain conduct that is protected from liability under the Federal anti-kickback statute, section 1128B(b) of the Social Security Act (the Act). Amendments include updating the provision under which electronic health records software is deemed interoperable; removing the electronic prescribing capability requirement; extending the sunset provision until December 31, 2021; limiting the scope of protected donors to exclude laboratory companies; and clarifying the condition that prohibits a donor from taking any action to limit or restrict the use, compatibility, or interoperability of the donated items or services.

The health fraud battle. Education is the best defense.

PubMed

Johnson, G C; Gottesman, R A

1989-06-01

Despite the regulatory and educational efforts of the Food and Drug Administration and other agencies and organizations, large numbers of American consumers continue to be fooled by unsubstantiated "miracle cure" claims made by manufacturers of fraudulent medical products. Physicians who are familiar with the language of health fraud advertising and product labels may be able to help patients avoid unnecessary expense, false hope, and physical and emotional harm.

Combating healthcare corruption and fraud with improved global health governance

PubMed Central

2012-01-01

Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of “global health corruption” and development of a treaty protocol to combat this crucial issue. PMID:23088820

Medicare and Medicaid fraud and abuse regulations.

PubMed

Liang, F Z; Black, B L

1991-11-01

Specific business arrangements that are protected under legislation and regulations governing parties doing business with Medicare or Medicaid are discussed. Regulations implementing the Medicare and Medicaid Patient Protection Act of 1987 specify practices and activities that are not subject to criminal penalties under the antikickback provisions of the Social Security Act or to exclusion from Medicare or state health-care programs. As of July 29, 1991, all organized health-care settings that receive payments from either Medicare or state health-care programs must comply with these regulations. The final rule sets forth "safe harbors"--exceptions to prohibitions against (1) kickbacks, bribes, rebates, and other illegal activities involving remunerations for patient referrals and (2) inducements to purchase or lease goods paid for by Medicare or state health-care programs. The safe harbors comprise 11 broad categories--investment interests, space rental, equipment rental, personal services and management contracts, purchase of a medical practice, referral services, warranties, discounts, employees, group purchasing organizations, and waiver of deductibles and coinsurance. Implications for pharmacy are discussed. These regulations will affect the purchase of pharmaceuticals by institutional pharmacies. Each institution should review its current practices to determine whether they are within the safe harbors.

42 CFR 1007.5 - Basic requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Basic requirement. 1007.5 Section 1007.5 Public... STATE MEDICAID FRAUD CONTROL UNITS § 1007.5 Basic requirement. A State Medicaid fraud control unit must... requirements of §§ 1007.7 through 1007.13 of this part. ...

45 CFR 79.1 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.1 Basis and purpose. (a) Basis. This part implements the Program Fraud Civil Remedies Act of 1986, Pub. L... for imposing civil penalties and assessments against persons who make, submit, or present, or cause to...

45 CFR 79.1 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.1 Basis and purpose. (a) Basis. This part implements the Program Fraud Civil Remedies Act of 1986, Pub. L... for imposing civil penalties and assessments against persons who make, submit, or present, or cause to...

45 CFR 79.1 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.1 Basis and purpose. (a) Basis. This part implements the Program Fraud Civil Remedies Act of 1986, Pub. L... for imposing civil penalties and assessments against persons who make, submit, or present, or cause to...

45 CFR 79.1 - Basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.1 Basis and purpose. (a) Basis. This part implements the Program Fraud Civil Remedies Act of 1986, Pub. L... for imposing civil penalties and assessments against persons who make, submit, or present, or cause to...

Government Increases Reliance on Universities to Detect and Probe Fraud by Own Researchers; Critics Are Wary.

ERIC Educational Resources Information Center

Wheeler, David L.

1987-01-01

University administrators are expected by federal agencies to detect, investigate, and judge scientific fraud and misconduct on their campuses. Both National Science Foundation and National Institutes of Health place primary responsibility on universities for spotting cases of scientific misconduct. (MLW)

Health Care Financing Administration--Medicare and Medicaid programs; protection of patients' funds. Final regulation.

PubMed

1980-07-24

This rule sets forth expanded standards for protection of personal funds of patients in skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) that participate in the Medicare or Medicaid programs. The changes are required for SNFs by Section 21(a) of Pub. L. 95-142, the Medicare-Medcaid Anti-Fraud and Abuse Amendments of 1977, and for ICFs by Section 8(c) of Pub. L. 95-292, the End-Stage Renal Disease Amendments of 1978. The intent is to safeguard patient funds from misuse by facilities, and to assure that personal funds held by the the facilities are fully accounted for and made available to patients when they need or want them.

Stem cell tourism and the power of hope.

PubMed

Murdoch, Charles E; Scott, Christopher Thomas

2010-05-01

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly on hope, the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm.

Health care fraud and abuse data collection program: technical revisions to Healthcare Integrity and Protection Data Bank data collection activities. Final rule.

PubMed

2004-09-21

The rule finalizes technical changes to the Healthcare Integrity and Protection Data Bank (HIPDB) data collection reporting requirements by clarifying the types of personal numeric identifiers that may be reported to the data bank in connection with adverse actions. The rule clarifies that in lieu of a Social Security Number (SSN), an individual taxpayer identification number (ITIN) may be reported to the data bank when, in those limited situations, an individual does not have an SSN.

The broad field of forensic pharmacy.

PubMed

Anderson, Peter D

2012-02-01

Forensic pharmacy is application of the sciences of drugs to legal issues. Forensic pharmacists engage in work relating to litigation, the regulatory process, and the criminal justice system. Forensic pharmacy overlaps with many other forensic fields. Pharmacists hold a variety of positions with local, state, and federal governments. Many pharmacists do freelance work as forensic litigation consultants. A forensic pharmacist can be a valuable resource in legal cases relating to malpractice, adverse drug reactions, drunk and drugged driving, health care fraud, poisoning, and numerous other types of civil and criminal cases.

45 CFR 79.1 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Basis and purpose. 79.1 Section 79.1 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.1 Basis and purpose. (a) Basis. This part implements the Program Fraud Civil Remedies Act of 1986, Pub. L...

45 CFR 30.3 - Antitrust, fraud, exception in the account of an accountable official, and interagency claims...

Code of Federal Regulations, 2010 CFR

2010-10-01

... accountable official, and interagency claims excluded. 30.3 Section 30.3 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION General Provisions § 30.3 Antitrust, fraud, exception in the account of an accountable official, and interagency claims excluded. (a) Claims involving...

Access to palliative care and hospice in nursing homes.

PubMed

Zerzan, J; Stearns, S; Hanson, L

2000-11-15

Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494.

Children with health issues.

PubMed

Schuster, Mark A; Chung, Paul J; Vestal, Katherine D

2011-01-01

All children, even the healthiest, have preventive and acute health care needs. Moreover, a growing number of children are chronically ill, with preventive, acute, and ongoing care needs that may be much more demanding than those for healthy children. Because children are unable to care for themselves, their parents are expected to provide a range of health care services without which the current health care system for children would not function. Under this "shadow health care system," parents or parent surrogates often need to be with the child, a requirement that can create difficulties for working parents, particularly for those whose children are chronically ill. How federal, state, and employer policies and practices mesh with the child health care needs of families is therefore a central issue in any discussion about work and family balance. In this article Mark Schuster, Paul Chung, and Katherine Vestal describe the health care needs of children; the essential health care responsibilities of parents; the perspective of employers; and the existing network of federal, state, and local family leave benefits that employed parents can access. They also identify current gaps in policies that leave unmet the needs of both parents and their employers. The authors suggest the outlines of a national family leave policy that would protect the interests of parents and employers. In essence, such a policy would build on the federal Family and Medical Leave Act, which gives some workers time off with no advance notice required and no loss of job or health insurance. But it would also include elements of California's Paid Family Leave Insurance, which expands coverage to more workers and provides partial pay during leave. Employers could be given some financial protections as well as protections against employee fraud and abuse. Such a policy, the authors conclude, would help to provide security to parents, minimize effects on employers, raise societal expectations for family-friendly work environments, and help maintain the parental shadow system of care on which health care professionals depend.

42 CFR 455.15 - Full investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Full investigation. 455.15 Section 455.15 Public... must— (1) In States with a State Medicaid fraud control unit certified under subpart C of part 1002 of... under § 1002.309 of this title; or (2) In States with no certified Medicaid fraud control unit, or in...

Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

PubMed

King, Michael W

2017-11-01

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for health care, rather than specifics for the delivery of health care. 4 With the U.S. expenditures on health care producing inferior results, experts see consolidation and alternatives to fee-for-service as fundamental to reducing costs. 5 Integrating care coordination and delivery and increasing scale to drive efficiencies allows organizations to benefit from shared savings and relationships with payors and vendors. 6 Deloitte forecasts that, by 2024, the current health system landscape-which includes roughly 80 national health systems, 275 regional systems, 130 academic medical centers, and 1,300 small community systems-will morph into just over 900 multi-hospital systems. 7 Even though health care market and payment reforms encourage organizations to consolidate and integrate, innovators must proceed with extreme caution. Health care organizations attempting to drive efficiencies and bring down costs through mergers may run afoul of numerous federal and state laws and regulations. 8 Calls for updates or leniency in these laws are growing, including the possible recognition of an "Obamacare defense" to antitrust restrictions 9 and speculation that laws restricting physicians from having financial relationships will be repealed, ostensibly to allow sharing of the rewards reaped from coordinated care. 10 In the meantime, however, absent specific waivers or exemptions, all the usual rules and regulations apply, including antitrust constraints, 11 physician self-referral 12 and anti-kickback laws and regulations, 13 state fraud and abuse restrictions, 14 and more. In short, a maelstrom of conflicting political prescriptions, health care regulations, and antitrust restrictions undermine the ability of innovators to achieve efficiencies through joint ventures, transactions, innovative models, and other structures. This article first considers the conflicting positions taken by the United States government with respect to achieving efficiencies in health care under the ACA and alternative delivery models, on the one hand, and health care regulatory enforcement and antitrust enforcement, on the other. At almost a fifth of the U.S. economy, 15 health care arguably has grown ungovernable, exceeding the ability of any one law or branch of government to create or implement coherent reform. Indeed, the article posits that although the ACA reformed and expanded access to health care, it failed to transform the way health care is delivered beyond limited "demonstration projects", leaving fee-for-service intact. Nonetheless, even with limited rather than revolutionary goals, the ACA still lacks sufficient authority across disparate branches of government to achieve its stated goals. The article then examines the conflicting positions of the various United States regulatory schemes and enforcement agencies governing health care, and whether they can be reconciled with the stated goal of the government, often referred to as the "Triple Aim": 16 improving quality of care, improving population health, and lowering health care costs. It examines fundamental, systemic challenges to achieving the "Triple Aim": longstanding health care regulatory laws that impede adoption of innovative delivery systems beyond their current "demonstration project" status, and antitrust enforcement that promotes waste and duplication in densely populated areas, while preventing necessary consolidation to more efficiently reach rural areas. The article concludes with recommendations for promoting efficiency through modest reconciliation of the conflicting goals and regulations in health care.

Automated Coding Software: Development and Use to Enhance Anti-Fraud Activities*

PubMed Central

Garvin, Jennifer H.; Watzlaf, Valerie; Moeini, Sohrab

2006-01-01

This descriptive research project identified characteristics of automated coding systems that have the potential to detect improper coding and to minimize improper or fraudulent coding practices in the setting of automated coding used with the electronic health record (EHR). Recommendations were also developed for software developers and users of coding products to maximize anti-fraud practices. PMID:17238546

75 FR 30411 - Privacy Act of 1974; Report of a Modified or Altered System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... Privacy Act of 1974; the Federal Information Security Management Act of 2002; the Computer Fraud and Abuse... Security Management Act of 2002; the Computer Fraud and Abuse Act of 1986; the Health Insurance Portability... systems and data files necessary for compliance with Title XI, Part C of the Social Security Act because...

Feds come knocking in search of home-care fraud.

PubMed

Burns, J

1995-06-05

Home care has become a target for federal investigators looking for ways to reduce the amount of money Medicare doles out to fraudulent providers. Companies and executives in the multibillion-dollar industry are facing charges ranging from filing bogus claims to money laundering.

Patient Protection and Affordable Care Act; program integrity: exchange, premium stabilization programs, and market standards; amendments to the HHS notice of benefit and payment parameters for 2014. Final rule.

PubMed

2013-10-30

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

Health care fraud and abuse data collection program: technical revisions to healthcare integrity and protection data bank data collection activities. Interim final rule with comment period.

PubMed

2004-06-17

The rule makes technical changes to the Healthcare Integrity and Protection Data Bank (HIPDB) data collection reporting requirements set forth in 45 CFR part 61 by clarifying the types of personal numeric identifiers that may be reported to the data bank in connection with adverse actions. Specifically, the rule clarifies that in lieu of a Social Security Number (SSN), an individual taxpayer identification number (ITIN) may be reported to the data bank when, in those limited situations, an individual does not have an SSN.

Making the case for a model mental health advance directive statute.

PubMed

Clausen, Judy A

2014-01-01

Acute episodes of mental illness temporarily destroy the capacity required to give informed consent and often prevent people from realizing they are sick, causing them to refuse intervention. Once a person refuses treatment, the only way to obtain care is as an involuntary patient. Even in the midst of acute episodes, many people do not meet commitment criteria because they are not likely to injure themselves or others and are still able to care for their basic needs. Left untreated, the episode will likely spiral out of control. By the time the person finally meets strict commitment criteria, devastation has already occurred. This Article argues that an individual should have the right to enter a Ulysses arrangement, a special type of mental health advance directive that authorizes a doctor to administer treatment during a future episode even if the episode causes the individual to refuse care. The Uniform Law Commissioners enacted the Uniform Health-Care Decisions Act as a model statute to address all types of advance health care planning, including planning for mental illness. However, the Act focuses on end-of-life care and fails to address many issues faced by people with mental illness. For example, the Act does not empower people to enter Ulysses arrangements and eliminates writing and witnessing requirements that protect against fraud and coercion. This Article recommends that the Uniform Law Commissioners adopt a model mental health advance directive statute that empowers people to enter Ulysses arrangements and provides safeguards against abuse. Appendix A sets forth model provisions.

Addressing the ethical, legal, and social issues raised by voting by persons with dementia.

PubMed

Karlawish, Jason H; Bonnie, Richard J; Appelbaum, Paul S; Lyketsos, Constantine; James, Bryan; Knopman, David; Patusky, Christopher; Kane, Rosalie A; Karlan, Pamela S

2004-09-15

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and formulation of uniform and workable policies for voting in long-term care settings. In some instances, extrapolation from existing policies and research permits reasonable recommendations to guide policy and practice. However, in other instances, additional research is necessary.

42 CFR 1001.2006 - Notice to others regarding exclusion.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) State Medicaid Fraud Control Units; (3) Utilization and Quality Control Quality Improvement Organizations; (4) Hospitals, skilled nursing facilities, home health agencies and health maintenance...

78 FR 32257 - Privacy Act of 1974; Report of a New Routine Use for Selected CMS Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-29

... systems of records to assist in preventing and detecting fraud, waste and abuse. The new routine use will... for the purpose of preventing and detecting fraud, waste and abuse, pursuant to section 1128C(a)(2) of the Social Security Act (``the Act''). At section 1128C(c) of the Act, a health plan is defined as a...

Preventing fraud and abuse in low income weatherization programs: The proceedings of the EORI (Economic Opportunity Research Institute) Roundtable

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1987-01-01

The Economic Opportunity Research Institute (EORI) sponsored a national Roundtable on ''Prevention of Fraud and Abuse in Low Income Weatherization Programs'' in Washington, DC on March 23-24, 1987. Funding for the Roundtable and these Proceedings was provided jointly by the US Departments of Health and Human Services/Office of Family Assistance and Energy through Grant FG01-85CE63438. The purpose of the Roundtable was two-fold: (1) to share successful and possible replicable state and local measures to prevent fraud and abuse in low income conservation programs; and (2) to identify any areas in these programs where the potential for fraud and abuse maymore » exist and examine methods to curb such potential. A Task Force representing eight states and including both state and local low income conservation program operators was chosen by EORI and the HHS Office of Family Assistance. The Agencies represented had developed successful preventive approaches to curbing fraud and abuse. Additional participants in the Roundtable included representatives from the US Department of Energy, Weatherization Assistance Program Office and the HHS Office of Energy Assistance, along with other state and local program operators.« less

Miracle Health Claims

MedlinePlus

... November 2011 You Might Also Like Dietary Supplements "Free" Trial Offers? 10 Things You Can Do to Avoid Fraud Search form Search menu Money & Credit Homes & Mortgages Health & Fitness Healthy Living Treatments & ...

Multi-stage methodology to detect health insurance claim fraud.

PubMed

Johnson, Marina Evrim; Nagarur, Nagen

2016-09-01

Healthcare costs in the US, as well as in other countries, increase rapidly due to demographic, economic, social, and legal changes. This increase in healthcare costs impacts both government and private health insurance systems. Fraudulent behaviors of healthcare providers and patients have become a serious burden to insurance systems by bringing unnecessary costs. Insurance companies thus develop methods to identify fraud. This paper proposes a new multistage methodology for insurance companies to detect fraud committed by providers and patients. The first three stages aim at detecting abnormalities among providers, services, and claim amounts. Stage four then integrates the information obtained in the previous three stages into an overall risk measure. Subsequently, a decision tree based method in stage five computes risk threshold values. The final decision stating whether the claim is fraudulent is made by comparing the risk value obtained in stage four with the risk threshold value from stage five. The research methodology performs well on real-world insurance data.

Some evidentiary considerations for physician billing.

PubMed

Rooks, Franklin J

2011-01-01

In a criminal prosecution for medical billing fraud alleging up-coding and overbilling, the government's evidence may encompass the practice's entire billings and draw inferences from them. In addition, fraud may be demonstrated through statistical analysis comparing a physician's billings relative to other providers of the same specialty. The Federal Rules of Evidence govern the admissibility of evidence during a trial, to provide fairness for both the prosecution and the defense. Physicians and practice managers should be well versed in the billing requirements and particularly careful when CPT codes are expressed in terms of "required times" as opposed to "typical times."

Unhealthy marketing of pharmaceutical products: An international public health concern.

PubMed

Mulinari, Shai

2016-05-01

I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care.

Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations. Extension of temporary moratoria.

PubMed

2018-01-30

This document announces the extension of statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non-emergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children's Health Insurance Program in those states. For purposes of these moratoria, providers that were participating as network providers in one or more Medicaid managed care organizations prior to January 1, 2018 will not be considered "newly enrolling" when they are required to enroll with the State Medicaid agency pursuant to a new statutory requirement, and thus will not be subject to the moratoria.

42 CFR 455.17 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Reporting requirements. 455.17 Section 455.17 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and...

FraudBuster: Reducing Fraud in an Auto Insurance Market.

PubMed

Nagrecha, Saurabh; Johnson, Reid A; Chawla, Nitesh V

2018-03-01

Nonstandard insurers suffer from a peculiar variant of fraud wherein an overwhelming majority of claims have the semblance of fraud. We show that state-of-the-art fraud detection performs poorly when deployed at underwriting. Our proposed framework "FraudBuster" represents a new paradigm in predicting segments of fraud at underwriting in an interpretable and regulation compliant manner. We show that the most actionable and generalizable profile of fraud is represented by market segments with high confidence of fraud and high loss ratio. We show how these segments can be reported in terms of their constituent policy traits, expected loss ratios, support, and confidence of fraud. Overall, our predictive models successfully identify fraud with an area under the precision-recall curve of 0.63 and an f-1 score of 0.769.

Corporate compliance plans in health care organizations: a top-down perspective.

PubMed

Forgione, D A

1998-01-01

Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down.

DHEC: Tuberculosis

Science.gov Websites

Skip to content South Carolina Department of Health and Environmental Control Search Button RSS Services Programs/Divisions Report State Agency Fraud Health Health All Health Topics Child and Teen Health Data, Maps - SC Public Health Diseases and Conditions Flu Tuberculosis STD/HIV and Viral Hepatitis Zika

DHEC: Vaccinations

Science.gov Websites

Skip to content South Carolina Department of Health and Environmental Control Search Button RSS Services Programs/Divisions Report State Agency Fraud Health Health All Health Topics Child and Teen Health Data, Maps - SC Public Health Diseases and Conditions Flu Tuberculosis STD/HIV and Viral Hepatitis Zika

DHEC: Flu Data, Reports, Maps

Science.gov Websites

Skip to content South Carolina Department of Health and Environmental Control Search Button RSS Services Programs/Divisions Report State Agency Fraud Health Health All Health Topics Child and Teen Health Data, Maps - SC Public Health Diseases and Conditions Flu Tuberculosis STD/HIV and Viral Hepatitis Zika

DHEC: General Agency Information

Science.gov Websites

Skip to content South Carolina Department of Health and Environmental Control Search Button RSS Services Programs/Divisions Report State Agency Fraud Health Health All Health Topics Child and Teen Health Data, Maps - SC Public Health Diseases and Conditions Flu Tuberculosis STD/HIV and Viral Hepatitis Zika

42 CFR 455.20 - Recipient verification procedure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Recipient verification procedure. 455.20 Section 455.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and...

42 CFR 455.12 - State plan requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false State plan requirement. 455.12 Section 455.12 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and...

Changing social policy: Grassroots to legislation.

PubMed

Lemiska, Liz; McCann, Eileen M; Mancuso, Margaret

2002-05-01

Health care in the United States has evolved into a multimillion dollar business. As the health care industry has grown, so too has government regulation and involvement. As both insurers and patients vie to get the most for their health care dollars, federal and state governments attempt to mediate, prevent fraud and abuse, and protect all parties involved. Consumers feel the effects of this "tug of war" in the form of higher copayments, premiums, and out-of-pocket costs, as well as denial of coverage. This denial of coverage sparked a very successful grassroots effort to stop commercial insurers in the state of Connecticut from defining ostomy supplies as cosmetic and thus denying reimbursement. A tremendous amount of collaboration between Connecticut WOC nurses, state legislators, local American Cancer Society advocates, United Ostomy Association chapter members, and health care providers resulted in a powerful mobilization and support for House Bill No. 5120. This bill went beyond defining ostomy supplies as medically necessary but also set a minimum rate for reimbursement. Social policy changed, improving the lives of Connecticut citizens with an ostomy. Although many people fear they do not have the power to make necessary changes in government, this experience proved otherwise. The collaboration that occurred was patient advocacy at its best. This article describes the process that allowed this successful collaboration to take place with the hope that others will be inspired to get involved with patient advocacy through political involvement. It is the intention of this work to capture the essence of dedication of a grassroots campaign involving a small group of well-organized, highly focused participants who were responsible for changing public health care policy in the state of Connecticut.

Medicaid program; Medicaid Management Information Systems; conditions of approval and reapproval and procedures for reduction of federal financial participation--Health Care Financing Administration. Proposed rule.

PubMed

1983-03-03

This proposal adds to regulations new conditions and procedures for initial approval and for reapproval of Medicaid Management Information Systems (MMIS) to update the regulations to reflect additional requirements added by section 901 of the Mental Health Systems Act of 1980 (Pub. L. 96-398). The proposal specifies procedures for reducing the level of Federal financial participation in a State's administrative expenditures when a State fails to meet the conditions for initial operation, initial approval or reapproval of an MMIS. It also proposes procedures with respect to waivers of the conditions of approval and reapproval and to appeals of adverse decisions. These provisions are intended to improve States' MMIS, and to ensure efficient system operations, and to detect cases of fraud, waste, and abuse effectively.

Medicare and Social Security: fraud and abuse; civil money penalties for misuse of certain terms, symbols and emblems--HHS. Final rule.

PubMed

1991-08-28

This final rule implements section 428(a) of Public Law 100-360 which authorizes the imposition of civil money penalties for the use--in advertising, solicitations or other communications--of certain words, letters, symbols or emblems associated with the Department of Health and Human Services' Social Security and Medicare programs in a manner that the user knows, or should know, would convey a false impression that (1) the communicated item was approved, endorsed or authorized by the Department or its programs, or (2) the responsible person or organization has some connection with, or authorization from, the Department or these programs. This rulemaking is designed to assist in protecting citizens from misrepresentations concerning the services offered and programs administered by the Social Security Administration and the Health Care Financing Administration.

42 CFR 455.19 - Provider's statement on check.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Provider's statement on check. 455.19 Section 455.19 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and...

42 CFR 455.18 - Provider's statements on claims forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Provider's statements on claims forms. 455.18 Section 455.18 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud...

New ethical code reflects expectations for industry behavior.

PubMed

Bailey, Pamela G

2005-07-01

Sporadic misbehavior, suspect sales and marketing practices, and the perceived deep pockets of the health care industry have put corporations and physicians alike at risk for investigation for fraud and abuse misconduct. The Advanced Medical Technology Association's (AdvaMed) Code of Ethics on Interactions with Healthcare Professionals addresses interactions between the technology industry and physicians, recommending appropriate behavior for partners engaged in developing, testing, learning, and applying often complex technical innovations. As this discussion shows, AdvaMed's industry code underscores uniformity between the drug and technology industries where similarities exist yet sets a distinct course where the needs of the two industries diverge. Health care professionals must be keenly aware of the differences and similarities of the overlapping codes of conducts. Provisions for allowable financial support for third-party conferences, sales and promotional meetings, industry-sponsored educational and training meetings, consulting arrangements, gifts to physicians, reimbursement for technical information, and charitable donations are all examined within the AdvaMed code of ethics and compared against codes and compliance guidance adopted by the American Medical Association; the Pharmaceutical Research and Manufacturers of America; and the US Department of Health and Human Services; Office of Inspector General.

A holistic approach to food safety risks: Food fraud as an example.

PubMed

Marvin, Hans J P; Bouzembrak, Yamine; Janssen, Esmée M; van der Fels-Klerx, H J; van Asselt, Esther D; Kleter, Gijs A

2016-11-01

Production of sufficient, safe and nutritious food is a global challenge faced by the actors operating in the food production chain. The performance of food-producing systems from farm to fork is directly and indirectly influenced by major changes in, for example, climate, demographics, and the economy. Many of these major trends will also drive the development of food safety risks and thus will have an effect on human health, local societies and economies. It is advocated that a holistic or system approach taking into account the influence of multiple "drivers" on food safety is followed to predict the increased likelihood of occurrence of safety incidents so as to be better prepared to prevent, mitigate and manage associated risks. The value of using a Bayesian Network (BN) modelling approach for this purpose is demonstrated in this paper using food fraud as an example. Possible links between food fraud cases retrieved from the RASFF (EU) and EMA (USA) databases and features of these cases provided by both the records themselves and additional data obtained from other sources are demonstrated. The BN model was developed from 1393 food fraud cases and 15 different data sources. With this model applied to these collected data on food fraud cases, the product categories that thus showed the highest probabilities of being fraudulent were "fish and seafood" (20.6%), "meat" (13.4%) and "fruits and vegetables" (10.4%). Features of the country of origin appeared to be important factors in identifying the possible hazards associated with a product. The model had a predictive accuracy of 91.5% for the fraud type and demonstrates how expert knowledge and data can be combined within a model to assist risk managers to better understand the factors and their interrelationships. Copyright © 2016 Elsevier Ltd. All rights reserved.

Crowdfunding our health: Economic risks and benefits.

PubMed

Renwick, Matthew J; Mossialos, Elias

2017-10-01

Crowdfunding is an expanding form of alternative financing that is gaining traction in the health sector. This article presents a typology for crowdfunded health projects and a review of the main economic benefits and risks of crowdfunding in the health market. We use evidence from a literature review, complimented by expert interviews, to extend the fundamental principles and established theories of crowdfunding to a health market context. Crowdfunded health projects can be classified into four types according to the venture's purpose and funding method. These are projects covering health expenses, fundraising health initiatives, supporting health research, or financing commercial health innovation. Crowdfunding could economically benefit the health sector by expanding market participation, drawing money and awareness to neglected health issues, improving access to funding, and fostering project accountability and social engagement. However, the economic risks of health-related crowdfunding include inefficient priority setting, heightened financial risk, inconsistent regulatory policies, intellectual property rights concerns, and fraud. Theorized crowdfunding behaviours such as signalling and herding can be observed in the market for health-related crowdfunding. Broader threats of market failure stemming from adverse selection and moral hazard also apply. Many of the discussed economic benefits and risks of crowdfunding health campaigns are shared more broadly with those of crowdfunding projects in other sectors. Where crowdfunding health care appears to diverge from theory is the negative externality inefficient priority setting may have towards achieving broader public health goals. Therefore, the market for crowdfunding health care must be economically stable, as well as designed to optimally and equitably improve public health. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

75 FR 81556 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

...: Notice of intent to develop regulations. SUMMARY: In accordance with section 205 of the Health Insurance.... Section 205 of the Health Insurance Portability and Accountability Act of 1996 Section 205 of the Health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Inspector General 42 CFR Part 1001 Solicitation...

Development of a Hazard Classification Scheme for Substances Used in the Fraudulent Adulteration of Foods.

PubMed

Everstine, Karen; Abt, Eileen; McColl, Diane; Popping, Bert; Morrison-Rowe, Sara; Lane, Richard W; Scimeca, Joseph; Winter, Carl; Ebert, Andrew; Moore, Jeffrey C; Chin, Henry B

2018-01-01

Food fraud, the intentional misrepresentation of the true identity of a food product or ingredient for economic gain, is a threat to consumer confidence and public health and has received increased attention from both regulators and the food industry. Following updates to food safety certification standards and publication of new U.S. regulatory requirements, we undertook a project to (i) develop a scheme to classify food fraud-related adulterants based on their potential health hazard and (ii) apply this scheme to the adulterants in a database of 2,970 food fraud records. The classification scheme was developed by a panel of experts in food safety and toxicology from the food industry, academia, and the U.S. Food and Drug Administration. Categories and subcategories were created through an iterative process of proposal, review, and validation using a subset of substances known to be associated with the fraudulent adulteration of foods. Once developed, the scheme was applied to the adulterants in the database. The resulting scheme included three broad categories: 1, potentially hazardous adulterants; 2, adulterants that are unlikely to be hazardous; and 3, unclassifiable adulterants. Categories 1 and 2 consisted of seven subcategories intended to further define the range of hazard potential for adulterants. Application of the scheme to the 1,294 adulterants in the database resulted in 45% of adulterants classified in category 1 (potentially hazardous). Twenty-seven percent of the 1,294 adulterants had a history of causing consumer illness or death, were associated with safety-related regulatory action, or were classified as allergens. These results reinforce the importance of including a consideration of food fraud-related adulterants in food safety systems. This classification scheme supports food fraud mitigation efforts and hazard identification as required in the U.S. Food Safety Modernization Act Preventive Controls Rules.

75 FR 38112 - Organization, Functions, and Delegations of Authority; Part G; Indian Health Service; Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Organization, Functions, and... Ethics Staff (PIES) (GAL1) (1) Directs the fact-finding and resolution of allegations of impropriety such as mismanagement of resources, fraud, waste, and abuse, violations of the Standards of Ethical...

6 Tip-offs to Rip-offs: Don't Fall for Health Fraud Scams

MedlinePlus

... are not the only health scams on the market. FDA found a fraudulent and expensive light therapy device with cure-all claims to treat fungal meningitis, Alzheimer’s, skin cancer, concussions and many other unrelated diseases. Generally, making health claims about a medical device without FDA ...

Mooring in safe harbors. Proposed rules set out what's legal, what's not under Medicare fraud and abuse laws.

PubMed

MacKelvie, C F; Sanborn, A B

1989-04-01

The 1977 Fraud and Abuse Amendments, which prohibit business relationships that increase Medicare utilization, have created uncertainty among healthcare providers as to which commercial arrangements are legal and which are not. In response to this uncertainty, Congress enacted the Medicare and Medicaid Patient and Program Protection Act of 1987, which required the Department of Health and Human Services to develop regulations that would specify allowable practices. The regulations proposed Jan. 23, 1989, specify "safe harbors" from criminal and civil penalties in the following areas: sales of physician practices, rental agreements, investments by providers, and personal services and management contracts. In addition, the Fraud and Abuse Amendments exempted referrals arising out of a bona fide employment relationship, properly disclosed discounts, and group purchasing arrangements. The proposed regulations attempt to clarify these exemptions. Unfortunately, the proposals do little to calm a healthcare industry that is jumpy about which transactions are permitted and which are not. This is partly because the Internal Revenue Service, Health and Human Services, and the Department of Justice often issue conflicting pronouncements regarding prohibited business transactions by tax-exempt providers.

Financial Fraud and Child Abuse

ERIC Educational Resources Information Center

Little, Allison Dare

2014-01-01

A modern form of abuse of children by parents and foster parents is to use the identity of children in their care for their own financial benefit, such as accessing their unused social security numbers to secure credit. This article reviews examples and implications of this identity theft.

Scientific Misconduct and the Myth of Self-Correction in Science.

PubMed

Stroebe, Wolfgang; Postmes, Tom; Spears, Russell

2012-11-01

The recent Stapel fraud case came as a shattering blow to the scientific community of psychologists and damaged both their image in the media and their collective self-esteem. The field responded with suggestions of how fraud could be prevented. However, the Stapel fraud is only one among many cases. Before basing recommendations on one case, it would be informative to study other cases to assess how these frauds were discovered. The authors analyze a convenience sample of fraud cases to see whether (social) psychology is more susceptible to fraud than other disciplines. They also evaluate whether the peer review process and replications work well in practice to detect fraud. There is no evidence that psychology is more vulnerable to fraud than the biomedical sciences, and most frauds are detected through information from whistleblowers with inside information. On the basis of this analysis, the authors suggest a number of strategies that might reduce the risk of scientific fraud. © The Author(s) 2012.

42 CFR 455.16 - Resolution of full investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 455.16 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and... further action; (2) Suspending or terminating the provider from participation in the Medicaid program; (3...

Leveraging the big-data revolution: CMS is expanding capabilities to spur health system transformation.

PubMed

Brennan, Niall; Oelschlaeger, Allison; Cox, Christine; Tavenner, Marilyn

2014-07-01

As the largest single payer for health care in the United States, the Centers for Medicare and Medicaid Services (CMS) generates enormous amounts of data. Historically, CMS has faced technological challenges in storing, analyzing, and disseminating this information because of its volume and privacy concerns. However, rapid progress in the fields of data architecture, storage, and analysis--the big-data revolution--over the past several years has given CMS the capabilities to use data in new and innovative ways. We describe the different types of CMS data being used both internally and externally, and we highlight a selection of innovative ways in which big-data techniques are being used to generate actionable information from CMS data more effectively. These include the use of real-time analytics for program monitoring and detecting fraud and abuse and the increased provision of data to providers, researchers, beneficiaries, and other stakeholders. Project HOPE—The People-to-People Health Foundation, Inc.

75 FR 26196 - Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

... Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers AGENCY: Office of Inspector... Special Fraud Alert. Specifically, the Updated Special Fraud Alert addressed the statutory provision...) 205-0007. SUPPLEMENTARY INFORMATION: In our publication of the OIG Updated Special Fraud Alert on...

Fighting Domestic and International Fraud in the Admissions and Registrar's Offices

ERIC Educational Resources Information Center

Koenig, Ann M.; Devlin, Edward

2012-01-01

The education sector is no stranger to fraud, unfortunately. This article provides best practice guidance in recognizing and dealing with fraud, with emphasis on domestic and international academic credential fraud. It includes practical approaches to academic document review and verification. Success in fighting fraud requires becoming informed,…

42 CFR 455.13 - Methods for identification, investigation, and referral.

Code of Federal Regulations, 2010 CFR

2010-10-01

... referral. 455.13 Section 455.13 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid... referral. The Medicaid agency must have— (a) Methods and criteria for identifying suspected fraud cases; (b...

42 CFR 495.368 - Combating fraud and abuse.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... identified as an overpayment regardless of recoupment from such providers, within 60 days of discovery of the...

7 CFR 276.3 - Negligence or fraud.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Negligence or fraud. 276.3 Section 276.3 Agriculture... Negligence or fraud. (a) General. If FNS determines that there has been negligence or fraud on the part of..., pay to FNS a sum equal to the amount of coupons issued as a result of such negligence or fraud. (b...

Payroll Fraud Prevention Act

THOMAS, 112th Congress

Sen. Brown, Sherrod [D-OH

2011-04-08

Senate - 04/08/2011 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Social Media and Rating Sites as Tools to Understanding Quality of Care: A Scoping Review

PubMed Central

Van de Belt, Tom H; Engelen, Lucien JLPG; Schoonhoven, Lisette; Kool, Rudolf B

2014-01-01

Background Insight into the quality of health care is important for any stakeholder including patients, professionals, and governments. In light of a patient-centered approach, it is essential to assess the quality of health care from a patient’s perspective, which is commonly done with surveys or focus groups. Unfortunately, these “traditional” methods have significant limitations that include social desirability bias, a time lag between experience and measurement, and difficulty reaching large groups of people. Information on social media could be of value to overcoming these limitations, since these new media are easy to use and are used by the majority of the population. Furthermore, an increasing number of people share health care experiences online or rate the quality of their health care provider on physician rating sites. The question is whether this information is relevant to determining or predicting the quality of health care. Objective The goal of our research was to systematically analyze the relation between information shared on social media and quality of care. Methods We performed a scoping review with the following goals: (1) to map the literature on the association between social media and quality of care, (2) to identify different mechanisms of this relationship, and (3) to determine a more detailed agenda for this relatively new research area. A recognized scoping review methodology was used. We developed a search strategy based on four themes: social media, patient experience, quality, and health care. Four online scientific databases were searched, articles were screened, and data extracted. Results related to the research question were described and categorized according to type of social media. Furthermore, national and international stakeholders were consulted throughout the study, to discuss and interpret results. Results Twenty-nine articles were included, of which 21 were concerned with health care rating sites. Several studies indicate a relationship between information on social media and quality of health care. However, some drawbacks exist, especially regarding the use of rating sites. For example, since rating is anonymous, rating values are not risk adjusted and therefore vulnerable to fraud. Also, ratings are often based on only a few reviews and are predominantly positive. Furthermore, people providing feedback on health care via social media are presumably not always representative for the patient population. Conclusions Social media and particularly rating sites are an interesting new source of information about quality of care from the patient’s perspective. This new source should be used to complement traditional methods, since measuring quality of care via social media has other, but not less serious, limitations. Future research should explore whether social media are suitable in practice for patients, health insurers, and governments to help them judge the quality performance of professionals and organizations. PMID:24566844

Social media and rating sites as tools to understanding quality of care: a scoping review.

PubMed

Verhoef, Lise M; Van de Belt, Tom H; Engelen, Lucien J L P G; Schoonhoven, Lisette; Kool, Rudolf B

2014-02-20

Insight into the quality of health care is important for any stakeholder including patients, professionals, and governments. In light of a patient-centered approach, it is essential to assess the quality of health care from a patient's perspective, which is commonly done with surveys or focus groups. Unfortunately, these "traditional" methods have significant limitations that include social desirability bias, a time lag between experience and measurement, and difficulty reaching large groups of people. Information on social media could be of value to overcoming these limitations, since these new media are easy to use and are used by the majority of the population. Furthermore, an increasing number of people share health care experiences online or rate the quality of their health care provider on physician rating sites. The question is whether this information is relevant to determining or predicting the quality of health care. The goal of our research was to systematically analyze the relation between information shared on social media and quality of care. We performed a scoping review with the following goals: (1) to map the literature on the association between social media and quality of care, (2) to identify different mechanisms of this relationship, and (3) to determine a more detailed agenda for this relatively new research area. A recognized scoping review methodology was used. We developed a search strategy based on four themes: social media, patient experience, quality, and health care. Four online scientific databases were searched, articles were screened, and data extracted. Results related to the research question were described and categorized according to type of social media. Furthermore, national and international stakeholders were consulted throughout the study, to discuss and interpret results. Twenty-nine articles were included, of which 21 were concerned with health care rating sites. Several studies indicate a relationship between information on social media and quality of health care. However, some drawbacks exist, especially regarding the use of rating sites. For example, since rating is anonymous, rating values are not risk adjusted and therefore vulnerable to fraud. Also, ratings are often based on only a few reviews and are predominantly positive. Furthermore, people providing feedback on health care via social media are presumably not always representative for the patient population. Social media and particularly rating sites are an interesting new source of information about quality of care from the patient's perspective. This new source should be used to complement traditional methods, since measuring quality of care via social media has other, but not less serious, limitations. Future research should explore whether social media are suitable in practice for patients, health insurers, and governments to help them judge the quality performance of professionals and organizations.

Medicare and state health care programs: fraud and abuse; safe harbors for certain electronic prescribing and electronic health records arrangements under the anti-kickback statute. Final rule.

PubMed

2006-08-08

As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Public Law 108-173, this final rule establishes a new safe harbor under the Federal anti-kickback statute for certain arrangements involving the provision of electronic prescribing technology. Specifically, the safe harbor would protect certain arrangements involving hospitals, group practices, and prescription drug plan (PDP) sponsors and Medicare Advantage (MA) organizations that provide to specified recipients certain nonmonetary remuneration in the form of hardware, software, or information technology and training services necessary and used solely to receive and transmit electronic prescription information. In addition, in accordance with section 1128B(b)(3)(E) of the Social Security Act (the Act), this final rule creates a separate new safe harbor for certain arrangements involving the provision of nonmonetary remuneration in the form of electronic health records software or information technology and training services necessary and used predominantly to create, maintain, transmit, or receive electronic health records.

How to Spot Health Fraud

MedlinePlus

... Time-Tested or New-Found Treatment "This revolutionary innovation is formulated by using proven principles of natural ... and a decades-old remedy. Claims of an "innovation," "miracle cure," "exclusive product," or "new discovery" or " ...

[The actual issues of health financing in foreign countries].

PubMed

Efremov, D V; Zhiliaeva, E P

2011-01-01

The article discusses the actions recommended by WHO and applied in foreign countries to overcome the issues concerning public health financing. The emphasis is made upon enhancing the effectiveness of implementation of available resources and struggle with corruption and fraud. The corresponding measures applied in the Russian Federation are listed.

A La Buena: Living Better. Bilingual Adult Proficiency Level Materials for Everyday Living.

ERIC Educational Resources Information Center

Smith, Philip D., Jr.; And Others

These bilingual English/Spanish Adult Proficiency Materials comprise three adult education courses in these areas: consumer education, health, and nutrition. Part 1, Consumer Education, covers these topics: money management, credit, frauds, consumer complaints, housing, utility bills, saving energy, banking, insurance (car, health, life), buying a…

[Nursing between ethic and aesthetic. Profession described by media].

PubMed

Gradellini, Cinzia; Idamou, Sara; Lusetti, Simona

2013-01-01

Nurse's role, according to the media, does not fit the role and evolution that nursing had in these last years: nursing remains unknown to public. Objective of research is to define how nurse's image is described by media. analysis of two newspapers, at national and local level with respect to articles about nurses, taking into account numbers of articles, position, topic (malpractice, frauds/crimes, job/economical cuts, praise). A second part of research has been focused on online newspapers, by using key words. Analysis of television medical dramas about presence of nurse, competences, relationship with physician/patient, social elements, context of work (acute or chronic), impact on patients welfare, and eventually ethical-deontological aspects has been carried out. on three hundred articles related health context, thirty-nine talk about nurse; five of those are in first page. 39% of articles regards frauds/crimes, 19% job/economical cuts, 15% malpractice. With respect to online articles, 66% concerns frauds/crimes. In medical dramas there is small attention to nurse who has generic competence as well as other health professional but doctor. The nurse character is played only by women. a low level of professionalism comes out both from newspaper and television. A specific professional identity is often absent furthermore nurses are relegated to a role of weakness in work and private circumstance.

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda.

PubMed

Bouchard, Maryse; Kohler, Jillian C; Orbinski, James; Howard, Andrew

2012-05-03

Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants' experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher wages and benefits for workers could be important and initial steps in improving access orthopaedic care and OMDs, and managing the global injury burden.

Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

PubMed Central

2012-01-01

Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct, whistleblower protection, and higher wages and benefits for workers could be important and initial steps in improving access orthopaedic care and OMDs, and managing the global injury burden. PMID:22554349

Professionalism and clinical autonomy in the practice of medicine.

PubMed

Morreim, E Haavi

2002-11-01

Professionalism in medicine requires a reasonable measure of freedom for physicians to determine patients needs based on their own judgment. However, because virtually every medical decision is also a spending decision, third-party payers concerned about rising health care costs have introduced cost-containment tactics that significantly limit physicians accustomed autonomy. In response, groups of physicians have filed class-action lawsuits against managed care plans, alleging causes of action such as fraud, breach of contract, extortion, and violations of federal RICO (Racketeer-Influenced and Corrupt Organizations) law. Such litigation may have merits, but it also faces significant obstacles, in part because the contracts involved may not actually have promised the broad measure of clinical autonomy that the physicians allege was promised, then denied. As physicians seek to restore and retain their professional autonomy, it will be important for them to be increasingly proactive in structuring or modifying the contracts under whose terms they practice as some physicians have successfully done.

The Health Care Financing Administration's new examination documentation criteria: minimum auditing standards for the neurologic examination to be used by Medicare and other payors. Report from the American Academy of Neurology Medical Economics and Management Subcommittee.

PubMed

Nuwer, M R; Sigsbee, B

1998-02-01

Medicare recently announced the adoption of minimum documentation criteria for the neurologic examination. These criteria are added to existing standards for the history and medical decision-making. These criteria will be used in compliance audits by Medicare and other payors. Given the current federal initiative to eliminate fraud in the Medicare program, all neurologists need to comply with these standards. These criteria are for documentation only. Neurologic standards of care require a more complex and diverse examination pertinent to the problem(s) under consideration. Further guidance as to the content of a neurologic evaluation is outlined in the article "Practice guidelines: Neurologic evaluation" (Neurology 1990; 40: 871). The level of history and examination required for specific services is defined in the American Medical Association current procedural terminology book. Documentation standards for examination of children are not yet defined.

Healthcare Privacy and Anti-Fraud Act

THOMAS, 113th Congress

Sen. Rubio, Marco [R-FL

2013-11-07

Senate - 11/07/2013 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

48 CFR 1652.232-71 - Payments-experience-rated contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for error or fraud, the subscription charges received for the Plan by the Employees Health Benefits... accounting, OPM will place any surplus demonstration project premiums in the regular Contingency Reserves of...

48 CFR 1652.232-70 - Payments-community-rated contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for error or fraud, the subscription charges received for the plan by the Employees Health Benefits... Administrative Reserve. After the final accounting, OPM will place any surplus demonstration project premiums in...

Payroll Fraud Prevention Act of 2013

THOMAS, 113th Congress

Sen. Casey, Robert P., Jr. [D-PA

2013-11-12

Senate - 11/12/2013 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

32 CFR 516.58 - Policies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... LITIGATION Remedies in Procurement Fraud and Corruption § 516.58 Policies. (a) Procurement fraud and... administrative remedies in significant cases of fraud or corruption relating to Army procurement. (d) The key... of fraud or corruption involving procurement. (g) Coordination on the status and disposition of cases...

76 FR 76573 - Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-07

... the regulations treat ICD-10 conversion costs; change the rules on deducting community benefit... policies; (2) rules governing how ICD-10 conversion costs, fraud reduction expenses, and community benefit... administrative costs associated with expatriate policies as evidenced from the public comments and the first two...

42 CFR 424.515 - Requirements for reporting changes and updates to, and the periodic revalidation of Medicare...

Code of Federal Regulations, 2010 CFR

2010-10-01

... care fraud problems, national initiatives, complaints, or other reasons that cause CMS to question the... indicating noncompliance with the statute or regulations by specific provider or supplier types. The schedule... statute and regulations by specific provider or supplier types indicates that less frequent validation is...

42 CFR 424.515 - Requirements for reporting changes and updates to, and the periodic revalidation of Medicare...

Code of Federal Regulations, 2011 CFR

2011-10-01

... care fraud problems, national initiatives, complaints, or other reasons that cause CMS to question the... indicating noncompliance with the statute or regulations by specific provider or supplier types. The schedule... statute and regulations by specific provider or supplier types indicates that less frequent validation is...

Fraud in scientific research – birth of the Concordat to uphold research integrity in the United Kingdom

PubMed Central

Khajuria, Ankur; Agha, Riaz

2014-01-01

Fraud in research has risen exponentially and recent high profile cases may just be the tip of the iceberg. This threatens to have a major impact on public health, with policy makers and clinicians acting on erroneous data. To address this, the new research “Concordat”, a consensus statement on research misconduct, has been published. Can it hold the key to rebuilding public confidence in scientific research in the United Kingdom? This review focuses on the concept of research misconduct, highlighting prominent cases and discussing strategies in order to restore confidence in the validity of scientific research. PMID:24262890

78 FR 22270 - Special Fraud Alert: Physician-Owned Entities

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

...] Special Fraud Alert: Physician-Owned Entities AGENCY: Office of Inspector General (OIG), HHS. ACTION... Physician-Owned Entities. Specifically, the Special Fraud Alert addressed physician-owned entities that... publication of the Special Fraud Alert on Physician-Owned Entities, an inadvertent error appeared in the DATES...

A Review of Financial Accounting Fraud Detection based on Data Mining Techniques

NASA Astrophysics Data System (ADS)

Sharma, Anuj; Kumar Panigrahi, Prabin

2012-02-01

With an upsurge in financial accounting fraud in the current economic scenario experienced, financial accounting fraud detection (FAFD) has become an emerging topic of great importance for academic, research and industries. The failure of internal auditing system of the organization in identifying the accounting frauds has lead to use of specialized procedures to detect financial accounting fraud, collective known as forensic accounting. Data mining techniques are providing great aid in financial accounting fraud detection, since dealing with the large data volumes and complexities of financial data are big challenges for forensic accounting. This paper presents a comprehensive review of the literature on the application of data mining techniques for the detection of financial accounting fraud and proposes a framework for data mining techniques based accounting fraud detection. The systematic and comprehensive literature review of the data mining techniques applicable to financial accounting fraud detection may provide a foundation to future research in this field. The findings of this review show that data mining techniques like logistic models, neural networks, Bayesian belief network, and decision trees have been applied most extensively to provide primary solutions to the problems inherent in the detection and classification of fraudulent data.

77 FR 46258 - Debit Card Interchange Fees and Routing

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-03

... the types of fraud, methods used to commit fraud, and available fraud-prevention methods. An issuer... 920(a)(5) requires the Board to consider (1) the nature, type, and occurrence of fraud in electronic..., merchant trade associations, a card-payment processor, technology companies, a member of Congress...

75 FR 52944 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... records. Upon the effective date of this notice, system OFHEO-07, ``Mortgage Fraud System'' published at 71 FR 6085 on February 6, 2006 will be deleted. The proposed system named ``Fraud Reporting System'' (FHFA-6) will maintain information of fraud or possible fraud involving the Federal National Mortgage...

Consumer Frauds and Deceptions: A Learning Module.

ERIC Educational Resources Information Center

Waddell, Fred E.; And Others

This manual is designed to assist helping professionals responsible for developing consumer education programs for older adults on the topic of consumer fraud and deception. In a modular presentation format, the materials address the following areas of concern: (1) types of frauds and deceptions such as money schemes, mail order fraud,…

78 FR 29055 - State Medicaid Fraud Control Units; Data Mining

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-17

...] State Medicaid Fraud Control Units; Data Mining AGENCY: Office of Inspector General (OIG), HHS. ACTION... Fraud Control Units (MFCU) from using Federal matching funds to identify fraud through screening and... Control Number (OCN) 0990-0162. Table 2 indicates the paperwork burden associated with the requirements of...

The ZeroAccess Auto-Clicking and Search-Hijacking Click Fraud Modules

DTIC Science & Technology

2013-12-16

payloads and instead began distributing Bitcoin miners and click fraud modules.3 From a technical perspective, the primary click fraud malware used in...this era operated in the indiscriminate “auto-clicking” fashion we describe in Section 5. Alongside the click fraud and Bitcoin payloads, ZeroAccess

32 CFR 516.67 - Overseas cases of fraud or corruption.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 3 2011-07-01 2009-07-01 true Overseas cases of fraud or corruption. 516.67... AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.67 Overseas cases of fraud or corruption. (a) Commanders of overseas major commands will establish procedures...

Fraud prevention in paying portal

NASA Astrophysics Data System (ADS)

Sandhu, P. S.; Senthilkumar, N. C.

2017-11-01

The purpose of presenting this paper is to give the idea to prevent the fraud in finance paying portals as fraud is increasing on daily basis and mostly in financial sector. So through this paper we are trying to prevent the fraud. This paper will give you the working algorithm through which you can able to prevent the fraud. Algorithm will work according to the spending amount of the user, which means that use will get categories into one of the low, medium, high or very high category.

Science as a Matter of Honour: How Accused Scientists Deal with Scientific Fraud in Japan.

PubMed

Pellegrini, Pablo A

2017-06-26

Practices related to research misconduct seem to have been multiplied in recent years. Many cases of scientific fraud have been exposed publicly, and journals and academic institutions have deployed different measures worldwide in this regard. However, the influence of specific social and cultural environments on scientific fraud may vary from society to society. This article analyzes how scientists in Japan deal with accusations of scientific fraud. For such a purpose, a series of scientific fraud cases that took place in Japan has been reconstructed through diverse sources. Thus, by analyzing those cases, the social basis of scientific fraud and the most relevant aspects of Japanese cultural values and traditions, as well as the concept of honour which is deeply involved in the way Japanese scientists react when they are accused of and publicly exposed in scientific fraud situations is examined.

Food Fraud Prevention: Policy, Strategy, and Decision-Making - Implementation Steps for a Government Agency or Industry.

PubMed

Spink, John; Fortin, Neal D; Moyer, Douglas C; Miao, Hong; Wu, Yongning

2016-01-01

This paper addresses the role of governments, industry, academics, and non-governmental organizations in Food Fraud prevention. Before providing strategic concepts for governments and authorities, definitions of Food Fraud are reviewed and discussed. Next there is a review of Food Fraud activities by the Global Food Safety Initiative (GFSI), the Elliott Review in the United Kingdom, the European Commission resolution on Food Fraud, and the US Food Safety Modernization Act including the Preventative Controls Rule. Two key concepts for governments or a company are: (1) formally, and specifically, mention food fraud as a food issue and (2) create an enterprise-wide Food Fraud prevention plan. The research includes a case study of the implementation of the concepts by a state or provincial agency. This analysis provides a foundation to review the role of science and technology in detection, deterrence and then contributing to prevention.

Valuing the human health damage caused by the fraud of Volkswagen.

PubMed

Oldenkamp, Rik; van Zelm, Rosalie; Huijbregts, Mark A J

2016-05-01

Recently it became known that Volkswagen Group has been cheating with emission tests for diesel engines over the last six years, resulting in on-road emissions vastly exceeding legal standards for nitrogen oxides in Europe and the United States. Here, we provide an estimate of the public health consequences caused by this fraud. From 2009 to 2015, approximately nine million fraudulent Volkswagen cars, as sold in Europe and the US, emitted a cumulative amount of 526 ktonnes of nitrogen oxides more than was legally allowed. These fraudulent emissions are associated with 45 thousand disability-adjusted life years (DALYs) and a value of life lost of at least 39 billion US dollars, which is approximately 5.3 times larger than the 7.3 billion US dollars that Volkswagen Group has set aside to cover worldwide costs related to the diesel emissions scandal. Copyright © 2016 Elsevier Ltd. All rights reserved.

An Overview of a Hybrid Fraud Scoring and Spike Detection Technique for Fraud Detection in Streaming Data

NASA Astrophysics Data System (ADS)

Laleh, Naeimeh; Azgomi, Mohammad Abdollahi

Credit card and personal loan applications have increased significantly. Application fraud is present when the application forms contain plausible and synthetic identity information or real stolen identity information. The monetary cost of application fraud is often estimated to be in the billions of dollars [1].

75 FR 2105 - Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-14

... Inspector General Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical... Register notice sets forth the recently issued OIG Updated Special Fraud Alert addressing telemarketing by durable medical equipment (DME) suppliers. For the most part, OIG Special Fraud Alerts address national...

76 FR 81904 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

... of New Safe Harbors and Special Fraud Alerts AGENCY: Office of Inspector General (OIG), HHS. ACTION... Special Fraud Alerts. DATES: To assure consideration, public comments must be delivered to the address... and Special Fraud Alerts. Please assist us by referencing the file code OIG-120-N. Inspection of...

Fraud Prevention and Employee Rationalization in New York State Public Schools

ERIC Educational Resources Information Center

Slezak, Kathleen

2013-01-01

Prompted by frequent media reports of school fraud and a lack of relevant K-12 literature, this research study was designed to investigate current fraud prevention practices in public school districts in New York State. Using a "fraud triangle" model, an analysis of existing legislation and professional practice guidelines reveals that…

A Social Marketing Campaign in Denver: Reducing the Risk of Elder Fraud

ERIC Educational Resources Information Center

McKenna, Judy; Miller, Jacque; Curtis, Lisa

2004-01-01

Acknowledging the pain and loss senior citizens experience due to fraud, the Denver District Attorney's Office launched a campaign--"Clergy Against Senior Exploitation (CASE)"--to reduce fraud perpetrated on older persons. The thrust of this project was preventing fraud by educating older adults through their religious affiliations in…

12 CFR 1806.303 - Fraud, waste and abuse.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Fraud, waste and abuse. 1806.303 Section 1806... BANK ENTERPRISE AWARD PROGRAM Terms and Conditions of Assistance § 1806.303 Fraud, waste and abuse. Any person who becomes aware of the existence or apparent existence of fraud, waste, or abuse of assistance...

A Simple and Effective Mass Spectrometric Approach to Identify the Adulteration of the Mediterranean Diet Component Extra-Virgin Olive Oil with Corn Oil.

PubMed

Di Girolamo, Francesco; Masotti, Andrea; Lante, Isabella; Scapaticci, Margherita; Calvano, Cosima Damiana; Zambonin, Carlo; Muraca, Maurizio; Putignani, Lorenza

2015-09-01

Extra virgin olive oil (EVOO) with its nutraceutical characteristics substantially contributes as a major nutrient to the health benefit of the Mediterranean diet. Unfortunately, the adulteration of EVOO with less expensive oils (e.g., peanut and corn oils), has become one of the biggest source of agricultural fraud in the European Union, with important health implications for consumers, mainly due to the introduction of seed oil-derived allergens causing, especially in children, severe food allergy phenomena. In this regard, revealing adulterations of EVOO is of fundamental importance for health care and prevention reasons, especially in children. To this aim, effective analytical methods to assess EVOO purity are necessary. Here, we propose a simple, rapid, robust and very sensitive method for non-specialized mass spectrometric laboratory, based on the matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS) coupled to unsupervised hierarchical clustering (UHC), principal component (PCA) and Pearson's correlation analyses, to reveal corn oil (CO) adulterations in EVOO at very low levels (down to 0.5%).

A Simple and Effective Mass Spectrometric Approach to Identify the Adulteration of the Mediterranean Diet Component Extra-Virgin Olive Oil with Corn Oil

PubMed Central

Di Girolamo, Francesco; Masotti, Andrea; Lante, Isabella; Scapaticci, Margherita; Calvano, Cosima Damiana; Zambonin, Carlo; Muraca, Maurizio; Putignani, Lorenza

2015-01-01

Extra virgin olive oil (EVOO) with its nutraceutical characteristics substantially contributes as a major nutrient to the health benefit of the Mediterranean diet. Unfortunately, the adulteration of EVOO with less expensive oils (e.g., peanut and corn oils), has become one of the biggest source of agricultural fraud in the European Union, with important health implications for consumers, mainly due to the introduction of seed oil-derived allergens causing, especially in children, severe food allergy phenomena. In this regard, revealing adulterations of EVOO is of fundamental importance for health care and prevention reasons, especially in children. To this aim, effective analytical methods to assess EVOO purity are necessary. Here, we propose a simple, rapid, robust and very sensitive method for non-specialized mass spectrometric laboratory, based on the matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS) coupled to unsupervised hierarchical clustering (UHC), principal component (PCA) and Pearson’s correlation analyses, to reveal corn oil (CO) adulterations in EVOO at very low levels (down to 0.5%). PMID:26340625

42 CFR 457.232 - Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General. 457.232 Section 457.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S...

48 CFR 252.203-7001 - Prohibition on persons convicted of fraud or other defense-contract-related felonies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... convicted of fraud or other defense-contract-related felonies. 252.203-7001 Section 252.203-7001 Federal... convicted of fraud or other defense-contract-related felonies. As prescribed in 203.570-3, use the following clause: Prohibition on Persons Convicted of Fraud or Other Defense-Contract-Related Felonies (DEC 2008...

78 FR 78807 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... of New Safe Harbors and Special Fraud Alerts AGENCY: Office of Inspector General (OIG), HHS. ACTION... statute (section 1128B(b) of the Social Security Act), as well as developing new OIG Special Fraud Alerts... revised safe harbors and Special Fraud Alerts. Please assist us by referencing the file code OIG-122-N...

77 FR 76434 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

... of New Safe Harbors and Special Fraud Alerts AGENCY: Office of Inspector General (OIG), HHS. ACTION... statute (section 1128B(b) of the Social Security Act), as well as developing new OIG Special Fraud Alerts... revised safe harbors and Special Fraud Alerts. Please assist us by referencing the file code OIG-121-N...

Developmental trajectories of offenders convicted of fraud: A follow-up to age 50 in a Dutch conviction cohort

PubMed Central

van der Geest, Victor R.; Weisburd, David; Blokland, Arjan A. J.

2016-01-01

This study describes the criminal careers of offenders convicted of fraud, distinguishing different career dimensions such as intermittency, versatility and specialization. Results indicate that most fraud offenders are versatile in the sense that they also have significant criminal records for other serious offending (that is, not fraud). At the same time they are also specialized in fraud. When we examine developmental trajectories of serious offending and next explore patterns of fraud for the groups identified, we find that offenders in our sample represent a heterogeneous group and that the classic divide between typical financial (for example, white-collar) offenders and common criminals does not apply to the majority of our sample. PMID:28989326

Fraud and abuse. Building an effective corporate compliance program.

PubMed

Matusicky, C F

1998-04-01

In 1997, General Health System (GHS), a not-for-profit integrated delivery system headquartered in Baton Rouge, Louisiana, developed a formal corporate compliance program. A newly appointed corporate compliance officer worked with key GHS managers and employees to assess the organization's current fraud and abuse prevention practices and recommend changes to meet new regulatory and organizational requirements. Then a structure for implementing these changes was developed, with staff training at its core. The program required a significant initial outlay of financial and human resources. The benefits to the organization, however, including a greater ability to respond quickly and effectively to possible compliance problems and better organizational communications, were worth the investment.

Retractions in the scientific literature: is the incidence of research fraud increasing?

PubMed

Steen, R Grant

2011-04-01

Scientific papers are retracted for many reasons including fraud (data fabrication or falsification) or error (plagiarism, scientific mistake, ethical problems). Growing attention to fraud in the lay press suggests that the incidence of fraud is increasing. The reasons for retracting 742 English language research papers retracted from the PubMed database between 2000 and 2010 were evaluated. Reasons for retraction were initially dichotomised as fraud or error and then analysed to determine specific reasons for retraction. Error was more common than fraud (73.5% of papers were retracted for error (or an undisclosed reason) vs 26.6% retracted for fraud). Eight reasons for retraction were identified; the most common reason was scientific mistake in 234 papers (31.5%), but 134 papers (18.1%) were retracted for ambiguous reasons. Fabrication (including data plagiarism) was more common than text plagiarism. Total papers retracted per year have increased sharply over the decade (r=0.96; p<0.001), as have retractions specifically for fraud (r=0.89; p<0.001). Journals now reach farther back in time to retract, both for fraud (r=0.87; p<0.001) and for scientific mistakes (r=0.95; p<0.001). Journals often fail to alert the naïve reader; 31.8% of retracted papers were not noted as retracted in any way. Levels of misconduct appear to be higher than in the past. This may reflect either a real increase in the incidence of fraud or a greater effort on the part of journals to police the literature. However, research bias is rarely cited as a reason for retraction.

FraudMiner: A Novel Credit Card Fraud Detection Model Based on Frequent Itemset Mining

PubMed Central

Seeja, K. R.; Zareapoor, Masoumeh

2014-01-01

This paper proposes an intelligent credit card fraud detection model for detecting fraud from highly imbalanced and anonymous credit card transaction datasets. The class imbalance problem is handled by finding legal as well as fraud transaction patterns for each customer by using frequent itemset mining. A matching algorithm is also proposed to find to which pattern (legal or fraud) the incoming transaction of a particular customer is closer and a decision is made accordingly. In order to handle the anonymous nature of the data, no preference is given to any of the attributes and each attribute is considered equally for finding the patterns. The performance evaluation of the proposed model is done on UCSD Data Mining Contest 2009 Dataset (anonymous and imbalanced) and it is found that the proposed model has very high fraud detection rate, balanced classification rate, Matthews correlation coefficient, and very less false alarm rate than other state-of-the-art classifiers. PMID:25302317

FraudMiner: a novel credit card fraud detection model based on frequent itemset mining.

PubMed

Seeja, K R; Zareapoor, Masoumeh

2014-01-01

This paper proposes an intelligent credit card fraud detection model for detecting fraud from highly imbalanced and anonymous credit card transaction datasets. The class imbalance problem is handled by finding legal as well as fraud transaction patterns for each customer by using frequent itemset mining. A matching algorithm is also proposed to find to which pattern (legal or fraud) the incoming transaction of a particular customer is closer and a decision is made accordingly. In order to handle the anonymous nature of the data, no preference is given to any of the attributes and each attribute is considered equally for finding the patterns. The performance evaluation of the proposed model is done on UCSD Data Mining Contest 2009 Dataset (anonymous and imbalanced) and it is found that the proposed model has very high fraud detection rate, balanced classification rate, Matthews correlation coefficient, and very less false alarm rate than other state-of-the-art classifiers.

Legally Sustainable Solutions for Privacy Issues in Collaborative Fraud Detection

NASA Astrophysics Data System (ADS)

Flegel, Ulrich; Kerschbaum, Florian; Miseldine, Philip; Monakova, Ganna; Wacker, Richard; Leymann, Frank

One company by itself cannot detect all instances of fraud or insider attacks. An example is the simple case of buyer fraud: a fraudulent buyer colludes with a supplier creating fake orders for supplies that are never delivered. They circumvent internal controls in place to prevent this kind of fraud, such as a goods receipt, e.g., by ordering services instead of goods. Based on the evidence collected at one company, it is often extremely difficult to detect such fraud, but if companies collaborate and correlate their evidence, they could detect that the ordered services have never actually been provided.

41 CFR 102-38.50 - What must we do when an executive agency suspects violations of 40 U.S.C. 559, fraud, bribery, or...

Code of Federal Regulations, 2010 CFR

2010-07-01

... executive agency suspects violations of 40 U.S.C. 559, fraud, bribery, or criminal collusion in connection... an executive agency suspects violations of 40 U.S.C. 559, fraud, bribery, or criminal collusion in.... 559, fraud, bribery, or criminal collusion in connection with the disposal of personal property, the...

Online Safety: Fraud, Security, Phishing, Vishing

MedlinePlus

... Theft Online Safety Privacy Report Scams and Frauds Online Safety Be aware of these scams when you' ... Security and Safety Internet Fraud Phishing and Vishing Online Security and Safety The internet makes many everyday ...

An Analysis of Internal Controls and Procurement Fraud Deterrence

DTIC Science & Technology

2013-12-01

might keep the organization from achieving its objectives and analyze risks , including fraud risk , so as to decide how the risk should be managed ( COSO ...internal control to adequately manage the risk ( COSO , 2013). Risk management involves developing the effective internal control targeted at a...structure and management . While the risk of fraud cannot be eliminated entirely, it can be greatly reduced with an appropriate procurement fraud prevention

Fraud Detection in Healthcare

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chandola, Varun; Schryver, Jack C; Sukumar, Sreenivas R

We discuss the problem of fraud detection in healthcare in this chapter. Given the recent scrutiny of the ineciencies in the US healthcare system, identifying fraud has been on the forefront of the eorts towards reducing the healthcare costs. In this chapter we will focus on understanding the issue of healthcare fraud in detail, and review methods that have been proposed in the literature to combat this issue using data driven approach.

32 CFR 516.68 - Program Fraud Civil Remedies Act (PFCRA).

Code of Federal Regulations, 2010 CFR

2010-07-01

... AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.68 Program Fraud Civil Remedies Act (PFCRA). (a) PFCRA was enacted on 21 October 1986 (Public Law 99-509) and...

Factsheets: Indicators of Fraud, Waste and Abuse

EPA Pesticide Factsheets

Factsheets: Indicators of Fraud, Waste and Abuse - You can tell if fraud, waste and abuse are occurring by looking for indicators. These are clues that may warrant further review of a specific area or activity.

48 CFR 3032.006 - Reduction or suspension of contract payments upon finding of fraud.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contract payments upon finding of fraud. 3032.006 Section 3032.006 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY, HOMELAND SECURITY ACQUISITION REGULATION (HSAR) GENERAL CONTRACTING... finding of fraud. ...

Bad Reaction to Cosmetics?

MedlinePlus

... Yourself Health Fraud Bad Reactions to Cosmetics? Tell FDA! Share Tweet Linkedin Pin it More sharing options ... 日本語 | فارسی | English FDA Accessibility Careers FDA Basics FOIA No FEAR Act ...

Avoiding Service Station Fraud.

ERIC Educational Resources Information Center

Burton, Grace M.; Burton, John R.

1982-01-01

High school students are warned against service station fraud. A problem-solving section is designed to help students calculate consumer costs for various fraudulent transactions. Several ways of reducing fraud or of lessening the chances of problems are noted. (MP)

Procurement Integrity in Contingency Operations: A Case Study of Army Contracting Officer Corruption in Operations Iraqi and Enduring Freedom Utilizing Occupational Fraud Theory

DTIC Science & Technology

2011-12-01

Study of Army Contracting Officer Corruption in Operations Iraqi and Enduring Freedom Utilizing Occupational Fraud Theory By: Amanda H...Operations Iraqi and Enduring Freedom Utilizing Occupational Fraud Theory 6. AUTHOR(S) Amanda H. Flint 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION...CCOs) during Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) by applying occupational fraud theory, specifically the classic sociological

Problems associated with substandard and counterfeit drugs in developing countries: a review article on global implications of counterfeit drugs in the era of antiretroviral (ARVs) drugs in a free market economy.

PubMed

Nsimba, Stephen E D

2008-12-01

To review the global implications associated with the use of substandard and or counterfeit drugs in developing and may be developed countries. The focus of this review is particularly on antiretroviral (ARVs), antimalarials and other drugs. Review of various literatures through Pub-Med, Medline, Google and Internet search to retrieve and download published materials was done by the author of this review paper. When patients receive a counterfeit medicines, they are subjected to multiple risks. They often suffer more than just an inconvenience; as they become victims of fraud medicines and are all put at risk of adverse effects from unprescribed medicines or substandard ingredients. Additionally, patients may lose confidence in health care professionals including their physician and pharmacist, and potentially modern medicine or the pharmaceutical industry in general. Counterfeit or substandard (poor quality) drugs pose threats to society; not only to the individual in terms of the health side effects experienced, but also to the public in terms of trade relations, economic implications, and the effects on global pandemics. It is vital for suppliers, providers, and patients to be aware of current trends in counterfeiting in order to best prepare for encounters with suspicious products. Furthermore, this is an issue that needs to be continually dealt with on national and international policy levels. Developing countries should try their level best to establish good laboratories for monitoring and checking quality of all pharmaceuticals manufactured locally and those imported or donated to these countries. The Ministries of Health and all stakeholders involved in this issue must ensure that all drugs meet the set or established international standards and national standards. Failure to do so will be to misuse the hard earned forex that is normally borrowed from banks for the procurement and distribution of drugs to its people. Indeed sub-standard medications do more harm than good to people's health and it is unethical to give such drugs to people. Of course, in any market, some corruption and fraud always exist, but there are few commercial markets where fraud can have such drastic impact on global health and welfare. It is essential, therefore, that a multi-faceted approach be used to control this problem which affects the international community and continuously threatens the health of millions of people especially in developing countries. Developing countries should try their best at all costs establish good laboratories for monitoring or checking for quality control for all pharmaceuticals locally manufactured and those imported (entering) or donated to countries to make sure that they meet the set or established international or national standards. Short of that countries will be wasting a lot of money using forex which has been borrowed in a form a loans procuring and distributing to its people sub-standard medications which will do more harm than good to its indigenous people and this is unethical per se to give people drugs not meeting required set international standards.

Ethics in exercise science research.

PubMed

Shephard, Roy J

2002-01-01

Ethical evaluation is a vital but sometimes neglected component of research policy in the exercise sciences. This article reviews some issues in human research, with particular reference to studies undertaken by the exercise scientist. The typical composition and functions of the research review committee are examined in the context of individual and institutional ethical norms. In multicentre trials, there are often problems in coordinating ethical approval between institutions. On-going monitoring of research may have value in the detection of fraud. A reduction in the secrecy of committee proceedings would allow a closer auditing of the research review process. Authors need to give more thought to developing appropriate research questions. Scarce resources may be wasted because of inappropriate study design or an inadequate statistical analysis of the results. The costs of any proposed investigation must be weighed carefully against possible benefits. Confidentiality is particularly important when collecting data at the worksite or over the internet. Informed consent should be based on a full disclosure of risks; the participant should be competent to understand the nature and magnitude of these risks, and undue pressure to participate in an experiment must be avoided. The opposition to placebo trials expressed in the Declaration of Helsinki requires careful consideration of the use of control groups, since regular exercise is known to benefit health. If research is conducted in under-developed societies, the standards of treatment of the participants should match those expected in developed societies. The publication of findings must be fair and well balanced; examples of fraud and misconduct continue to be reported. Some journals apparently still publish papers, even if they have not received an initial institutional review. Editors should restore meaning to the word 'author', avoid the bias to a publication of 'positive' results, limit the impact of commercial sponsorship on reporting and curtail the current trend to redundant presentations and publications. Development of academic courses in research ethics may help to avoid some of these abuses.

Questionable, Objectionable or Criminal? Public Opinion on Data Fraud and Selective Reporting in Science.

PubMed

Pickett, Justin T; Roche, Sean Patrick

2018-02-01

Data fraud and selective reporting both present serious threats to the credibility of science. However, there remains considerable disagreement among scientists about how best to sanction data fraud, and about the ethicality of selective reporting. The public is arguably the largest stakeholder in the reproducibility of science; research is primarily paid for with public funds, and flawed science threatens the public's welfare. Members of the public are able to make meaningful judgments about the morality of different behaviors using moral intuitions. Legal scholars emphasize that to maintain legitimacy, social control policies must be developed with some consideration given to the public's moral intuitions. Although there is a large literature on popular attitudes toward science, there is no existing evidence about public opinion on data fraud or selective reporting. We conducted two studies-a survey experiment with a nationwide convenience sample (N = 821), and a follow-up survey with a representative sample of US adults (N = 964)-to explore community members' judgments about the morality of data fraud and selective reporting in science. The findings show that community members make a moral distinction between data fraud and selective reporting, but overwhelmingly judge both behaviors to be immoral and deserving of punishment. Community members believe that scientists who commit data fraud or selective reporting should be fired and banned from receiving funding. For data fraud, most Americans support criminal penalties. Results from an ordered logistic regression analysis reveal few demographic and no significant partisan differences in punitiveness toward data fraud.

5 CFR 6701.107 - Reporting waste, fraud, abuse and corruption.

Code of Federal Regulations, 2010 CFR

2010-01-01

... corruption. 6701.107 Section 6701.107 Administrative Personnel GENERAL SERVICES ADMINISTRATION SUPPLEMENTAL..., fraud, abuse and corruption. GSA employees shall disclose immediately any waste, fraud, abuse, and corruption to appropriate authorities, such as the Office of Inspector General. ...

5 CFR 6701.107 - Reporting waste, fraud, abuse and corruption.

Code of Federal Regulations, 2011 CFR

2011-01-01

... corruption. 6701.107 Section 6701.107 Administrative Personnel GENERAL SERVICES ADMINISTRATION SUPPLEMENTAL..., fraud, abuse and corruption. GSA employees shall disclose immediately any waste, fraud, abuse, and corruption to appropriate authorities, such as the Office of Inspector General. ...

Corruption and internal fraud in the Turkish construction industry.

PubMed

Gunduz, Murat; Önder, Oytun

2013-06-01

The purpose of this paper is to develop an understanding about the internal fraud and corruption problem in the Turkish construction industry. The reasons behind the internal fraud and corruption problem as well as the types of prevention methods were investigated; and as a result various recommendations were made. To this end, a risk awareness questionnaire was used to understand the behavioral patterns of the construction industry, and to clarify possible proactive and reactive measures against internal fraud and corruption. The type of fraud experienced by Turkish construction companies was also surveyed in the questionnaire. The questionnaire was sent to 89 firms; and depending on the collected data, certain recommendations for construction industry professionals were provided.

[Scientific fraud. A disease we find among ourselves].

PubMed

Guimarães, S

1998-01-01

Scientific fraud is not a problem exclusive to countries with high scientific development. Fraud does not necessarily mean invention of results, usurpation of ideas, manifest plagiarism or any other kind of serious scientific misconduct. Although more rare in countries where scientific production is more modest, pungent cases of scientific fraud also exist. However, less notorious cases of scientific misconduct are frequent and must be avoided. Examples of these less notorious sins are presented. The seriousness of scientific fraud is not only due to the fact that it may involve public funds, which could have been put to more useful purposes but, above all, because it violates scientific ethics and frustrates the final aim of science, the discovery of truth.

Fraud and plagiarisim in school and career.

PubMed

Agud, J L

2014-10-01

Between 0% and 94% of university students acknowledge having committed academic fraud. Its forms are varied: cheating on examinations, submitting someone else's work, plagiarism, false citations, false reporting on experiments, tests or findings in the medical history and physical examination, unfair behavior toward fellow students, and many others. The consequences of academic fraud include learning corruption, useless efforts by students and faculty, incorrect performance evaluations and unfair selection for jobs. Since this can be a prelude to future fraud as doctors or researches, the prevalence, risk factors, motivations, clinical appearances, detection and prevention of the disease of academic fraud are here reviewed. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

AICPA standard aids in detecting risk factors for fraud. American Institute of Certified Public Accountants.

PubMed

Reinstein, A; Dery, R J

1999-10-01

The American Institute of Certified Public Accountants' Statement on Auditing Standards (SAS) No. 82, Consideration of Fraud in a Financial Statement Audit, requires independent auditors to obtain reasonable assurance that financial statements are free of material mis-statements caused by error or fraud. SAS No. 82 provides guidance for independent auditors to use to help detect and document risk factors related to potential fraud. But while SAS No. 82 suggests how auditors should assess the potential for fraud, it does not expand their detection responsibility. Accordingly, financial managers should discuss thoroughly with auditors the scope and focus of an audit as a means to further their compliance efforts.

Fraud and fiduciary liability.

PubMed

Hodge, Brian Ray

2003-12-01

All employee benefit plans are potential targets of fraudulent schemes. Smaller plans are targeted by unscrupulous brokers and promoters selling fraudulent policies; plans large enough to be self-insured face greater risks of fraud by providers and participants misrepresenting claims. Plan trustees, administrators and consultants should be alert to the many ways fraudulent schemes manifest themselves and to the legal remedies available; establish investigative programs to detect and discourage fraud; and promote education and plan incentives for participants to report fraud.

Credit Card Fraud Detection: A Realistic Modeling and a Novel Learning Strategy.

PubMed

Dal Pozzolo, Andrea; Boracchi, Giacomo; Caelen, Olivier; Alippi, Cesare; Bontempi, Gianluca

2017-09-14

Detecting frauds in credit card transactions is perhaps one of the best testbeds for computational intelligence algorithms. In fact, this problem involves a number of relevant challenges, namely: concept drift (customers' habits evolve and fraudsters change their strategies over time), class imbalance (genuine transactions far outnumber frauds), and verification latency (only a small set of transactions are timely checked by investigators). However, the vast majority of learning algorithms that have been proposed for fraud detection rely on assumptions that hardly hold in a real-world fraud-detection system (FDS). This lack of realism concerns two main aspects: 1) the way and timing with which supervised information is provided and 2) the measures used to assess fraud-detection performance. This paper has three major contributions. First, we propose, with the help of our industrial partner, a formalization of the fraud-detection problem that realistically describes the operating conditions of FDSs that everyday analyze massive streams of credit card transactions. We also illustrate the most appropriate performance measures to be used for fraud-detection purposes. Second, we design and assess a novel learning strategy that effectively addresses class imbalance, concept drift, and verification latency. Third, in our experiments, we demonstrate the impact of class unbalance and concept drift in a real-world data stream containing more than 75 million transactions, authorized over a time window of three years.

Report: EPA Did Not Identify Volkswagen Emissions Cheating; Enhanced Controls Now Provide Reasonable Assurance of Fraud Detection

EPA Pesticide Factsheets

Report #18-P-0181, May 15, 2018. After uncovering VW's emissions fraud, the EPA's light-duty vehicle compliance program added controls to effectively detect and prevent noncompliance—a precursor to potential fraud.

Security systems engineering overview

NASA Astrophysics Data System (ADS)

Steele, Basil J.

1997-01-01

Crime prevention is on the minds of most people today. The concern for public safety and the theft of valuable assets are being discussed at all levels of government and throughout the public sector. There is a growing demand for security systems that can adequately safeguard people and valuable assets against the sophistication of those criminals or adversaries who pose a threat. The crime in this country has been estimated at 70 billion dollars in direct costs and up to 300 billion dollars in indirect costs. Health insurance fraud alone is estimated to cost American businesses 100 billion dollars. Theft, warranty fraud, and counterfeiting of computer hardware totaled 3 billion dollars in 1994. A threat analysis is a prerequisite to any security system design to assess the vulnerabilities with respect to the anticipated threat. Having established a comprehensive definition of the threat, crime prevention, detection, and threat assessment technologies can be used to address these criminal activities. This talk will outline the process used to design a security system regardless of the level of security. This methodology has been applied to many applications including: government high security facilities; residential and commercial intrusion detection and assessment; anti-counterfeiting/fraud detection technologies; industrial espionage detection and prevention; security barrier technology.

45 CFR 79.19 - Prehearing conferences.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Prehearing conferences. 79.19 Section 79.19 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.19 Prehearing conferences. (a) The ALJ may schedule prehearing conferences as appropriate. (b) Upon...

45 CFR 79.21 - Discovery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Discovery. 79.21 Section 79.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.21 Discovery. (a) The following types of discovery are authorized: (1) Requests for production of documents for...

45 CFR 79.4 - Investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Investigation. 79.4 Section 79.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.4 Investigation. (a) If an investigating official concludes that a subpoena pursuant to the authority conferred by...

45 CFR 79.21 - Discovery.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Discovery. 79.21 Section 79.21 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.21 Discovery. (a) The following types of discovery are authorized: (1) Requests for production of documents for...

45 CFR 79.21 - Discovery.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Discovery. 79.21 Section 79.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.21 Discovery. (a) The following types of discovery are authorized: (1) Requests for production of documents for...

45 CFR 79.21 - Discovery.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Discovery. 79.21 Section 79.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.21 Discovery. (a) The following types of discovery are authorized: (1) Requests for production of documents for...

45 CFR 79.21 - Discovery.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Discovery. 79.21 Section 79.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.21 Discovery. (a) The following types of discovery are authorized: (1) Requests for production of documents for...

49 CFR 1540.103 - Fraud and intentional falsification of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY CIVIL AVIATION SECURITY: GENERAL RULES Responsibilities of Passengers and Other Individuals and Persons § 1540.103 Fraud... 49 Transportation 9 2010-10-01 2010-10-01 false Fraud and intentional falsification of records...

42 CFR 455.17 - Reporting requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and Investigation Program § 455.17 Reporting requirements. The agency must report the following fraud or abuse... complaints of fraud and abuse made to the agency that warrant preliminary investigation. (b) For each case of...

Healthcare Fraud and Abuse

PubMed Central

Rudman, William J; Eberhardt, John S; Pierce, William; Hart-Hester, Susan

2009-01-01

In Texas, a supplier of durable medical equipment was found guilty of five counts of healthcare fraud due to submission of false claims to Medicare. The court sentenced the supplier to 120 months of incarceration and restitution of $1.6 million.1 Raritan Bay Medical Center agreed to pay the government $7.5 million to settle allegations that it defrauded the Medicare program, purposely inflating charges for inpatient and outpatient care, artificially obtaining outlier payments from Medicare.2 AmeriGroup Illinois, Inc., fraudulently skewed enrollment into the Medicaid HMO program by refusing to register pregnant women and discouraging registration for individuals with preexisting conditions. Under the False Claims Act and the Illinois Whistleblower Reward and Protection Act, AmeriGroup paid $144 million in damages to Illinois and the U.S. government and $190 million in civil penalties.3 In Florida, a dermatologist was sentenced to 22 years in prison, paid $3.7 million in restitution, forfeited an addition $3.7 million, and paid a $25,000 fine for performing 3,086 medically unnecessary surgeries on 865 Medicare beneficiaries.4 In Florida, a physician was sentenced to 24 months incarceration, ordered to pay $727,000 in restitution for cash payments where the physician signed blank prescriptions and certificates for medical necessity for patients he never saw.5 The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) found that providers in 8 out of 10 audited states received an estimated total of $27.3 million in Medicaid overpayments for services claimed after beneficiaries' deaths.6 PMID:20169019

Fighting Fraud in Schools

ERIC Educational Resources Information Center

Dessoff, Alan

2009-01-01

It's no surprise that school districts are as vulnerable to fraud as the private sector or any other segment of government. Crimes in districts include collusion with outside vendors who provide kickbacks to employees, misuse of district-issued credit cards, embezzlement of district funds, and theft of district property. "Fraud happens…

Fraud Education for Accounting Students.

ERIC Educational Resources Information Center

Peterson, Bonita K.

2003-01-01

Reports that limited fraud education takes place in accounting due to a crowded curriculum and misunderstanding of the extent of fraud. Suggests ways to develop content on the topic and provides a list of teaching materials (textbooks, workbooks, trade books, case materials, videos, and reference materials). (Contains 16 references.) (SK)

76 FR 7239 - Proposed Privacy Act Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-09

... property interests, identity theft or fraud, or harm to the security or integrity of this system or other... notice of a proposed system of records entitled, ``Treasury/DO .225 --TARP Fraud Investigation...: Supervisory Fraud Specialist, Office of Financial Stability, 1500 Pennsylvania Avenue, NW., Washington, DC...

Electronic Fraud on Campus.

ERIC Educational Resources Information Center

Sauter, David M.

1998-01-01

It is surprisingly easy for today's students to change grades, falsify documents, or create bogus diplomas. Explores the extent of the problem and offers ideas on ways in which colleges can protect themselves and society from the consequences of educational fraud. Addresses staff training, distribution of information regarding fraud, and improving…

49 CFR 1522.3 - Fraud and intentional falsification of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Fraud and intentional falsification of records...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY SECURITY RULES FOR ALL MODES OF TRANSPORTATION TSA-APPROVED VALIDATION FIRMS AND VALIDATORS General § 1522.3 Fraud and intentional falsification...

76 FR 5212 - Employment and Training Administration

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-28

... Collection for Internal Fraud and Overpayment Detection and Recovery Activities (OMB Control No. 1205-0187... of data on a revised form ETA 9000 that provides information about Internal Fraud and Overpayment...: I. Background The ETA 9000 is the only data source available on: (1) Instances of internal fraud...

When Good Money Goes Bad: True Stories of Contract Fraud at EPA

EPA Pesticide Factsheets

In an effort to provide you with tools to identify areas that may be of concern or worth looking into, this booklet was designed to provide an overview of general fraud indicators as well as highlight some specific indicators related to contract fraud.

7 CFR 226.25 - Other provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... result of funds received under the Act. (e) Fraud penalty. Whoever embezzles, willfully misapplies, steals, or obtains by fraud any funds, assets, or property that are the subject of a grant or other form..., assets, or property have been embezzled, willfully misapplied, stolen, or obtained by fraud shall, if...

7 CFR 226.25 - Other provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... result of funds received under the Act. (e) Fraud penalty. Whoever embezzles, willfully misapplies, steals, or obtains by fraud any funds, assets, or property that are the subject of a grant or other form..., assets, or property have been embezzled, willfully misapplied, stolen, or obtained by fraud shall, if...

7 CFR 225.18 - Miscellaneous administrative provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... receive approval from FNSRO. (g) Fraud penalty. Whoever embezzles, willfully misapplies, steals, or obtains by fraud any funds, assets, or property that are the subject of a grant or other form of... property have been embezzled, willfully misapplied, stolen or obtained by fraud shall, if such funds...

48 CFR 949.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fraud or other criminal conduct. 949.106 Section 949.106 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 949.106 Fraud or other criminal conduct. Any evidence...

48 CFR 1449.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fraud or other criminal conduct. 1449.106 Section 1449.106 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 1449.106 Fraud or other criminal conduct...

48 CFR 649.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Fraud or other criminal conduct. 649.106 Section 649.106 Federal Acquisition Regulations System DEPARTMENT OF STATE CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles. 649.106 Fraud or other criminal conduct. If the...

48 CFR 1349.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fraud or other criminal conduct. 1349.106 Section 1349.106 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 1349.106 Fraud or other criminal conduct. If the...

48 CFR 49.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Fraud or other criminal conduct. 49.106 Section 49.106 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 49.106 Fraud or other criminal conduct. If...

7 CFR 1580.504 - Fraud and recovery of overpayments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Fraud and recovery of overpayments. 1580.504 Section 1580.504 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE TRADE ADJUSTMENT ASSISTANCE FOR FARMERS § 1580.504 Fraud and recovery...

32 CFR 516.62 - PFD and HQ USACIDC coordination.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.62 PFD and HQ... procurement fraud or corruption investigations being conducted by USACIDC and possible remedies. These... affected by a significant investigation of fraud or corruption that relates to DOD procurement activities...

When Good Money Goes Bad: True Stories of Grant Fraud at EPA

EPA Pesticide Factsheets

In an effort to provide you with tools to identify areas that may be of concern or worth looking into, this booklet was designed to provide an overview of general fraud indicators as well as highlight some specific indicators related to grant fraud.

The "first digit law" - A hypothesis on its possible impact on medicine and development aid.

PubMed

Pollach, Gregor; Brunkhorst, Frank; Mipando, Mwapatsa; Namboya, Felix; Mndolo, Samson; Luiz, Thomas

2016-12-01

The "first digit law" or "Benford's law" is a mathematical distribution discovered by Simon Newcomb and Frank Benford. It states, that the probability of the leading number d (d∈{1,…,9}) in many natural datasets follows: P (d)=log 10 (d+1)-log 10 (d)=log 10 (1+1/d). It was successfully used through tax authorities and "forensic accounting" in order to detect fraud and other irregularities. Benfords law was almost neglected for its use outside financial accounting. The planning for health care systems in developing countries is extremely dependant on good, valid data. Whether you plan the catchment area for the future district hospitals, the number of health posts, the staff establishment for the central hospital or the drug budget in the Ministry. The "first digit law" can be used in medicine, public health, physiology and development aid to unmask questionable data, to discover unexpected challenges, difficulties in the data collection process, loss through corruption and criminal fraud. Our hypothesis suggests, that the "first digit law" is a cost effective tool, which is easy to use for most people in the medical profession, which does not really needs complicated statistical software and can be used on the spot, even in the resource restricted conditions of developing countries. Several preconditions (like the size of the data set and its reach over more than two dimensions) have to be fulfilled, but then Benfords law can be used by any clinician, physiologist, public health specialist or aid consultant without difficulties and without deeper statistical knowledge in the four steps, we suggest in this article. The consequences will be different depending on the level (local regional, national, continental, international) on which you will use the law. All levels will be enabled to get insight into the validity of the data-challenges for the other levels without the help of trained statisticians or accountants. We believe that the "first digit law" is a vastly underestimated and neglected, but extremely useful tool for the identification of unexpected challenges, supervision and control in various parts of medicine and public health for almost all aspects of development aid. Copyright © 2016 Elsevier Ltd. All rights reserved.

42 CFR 457.915 - Fraud detection and investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and abuse cases. (2) Methods for investigating fraud and abuse cases that— (i) Do not infringe on legal rights of persons involved; and (ii) Afford due process of law. (b) State program integrity unit... implement procedures for referring suspected fraud and abuse cases to the State program integrity unit (if...

32 CFR 516.60 - Procurement fraud and irregularities programs at MACOMs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Procurement fraud and irregularities programs at MACOMs. 516.60 Section 516.60 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption...

20 CFR 356.2 - Program Fraud Civil Remedies Act of 1986.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Program Fraud Civil Remedies Act of 1986. 356.2 Section 356.2 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 356.2 Program Fraud Civil Remedies Act...

20 CFR 632.125 - Responsibilities of Native American grantees, subgrantees and contractors for preventing fraud...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., subgrantees and contractors for preventing fraud and program abuse and for general program management. 632.125... and for general program management. (a) Each Native American grantee shall establish and use internal program management procedures sufficient to prevent fraud and program abuse, including subgrantee and...

20 CFR 632.125 - Responsibilities of Native American grantees, subgrantees and contractors for preventing fraud...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., subgrantees and contractors for preventing fraud and program abuse and for general program management. 632.125... and for general program management. (a) Each Native American grantee shall establish and use internal program management procedures sufficient to prevent fraud and program abuse, including subgrantee and...

17 CFR 32.9 - Fraud in connection with commodity option transactions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Fraud in connection with commodity option transactions. 32.9 Section 32.9 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGULATION OF COMMODITY OPTION TRANSACTIONS § 32.9 Fraud in connection with commodity...

17 CFR 33.10 - Fraud in connection with commodity option transactions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Fraud in connection with commodity option transactions. 33.10 Section 33.10 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGULATION OF DOMESTIC EXCHANGE-TRADED COMMODITY OPTION TRANSACTIONS § 33.10 Fraud in...

49 CFR 1570.5 - Fraud and intentional falsification of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Fraud and intentional falsification of records...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY MARITIME AND LAND TRANSPORTATION SECURITY GENERAL RULES § 1570.5 Fraud and intentional falsification of records. No person may make, cause to be...

Transcript Fraud and Handling Fraudulent Documents

ERIC Educational Resources Information Center

Ezell, Allen

2005-01-01

Transcript fraud is a common problem for colleges and universities, businesses, employers, governmental licensing boards, and other agencies, with some experiencing it more so than others. The only difference between a large and small institution is the volume of degree and transcript fraud it experiences. This article discusses the types and…

48 CFR 449.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Fraud or other criminal conduct. 449.106 Section 449.106 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 449.106 Fraud or other criminal conduct. (a) If the...

Consumer Fraud: An Empirical Perspective. Summary.

ERIC Educational Resources Information Center

Schubert, Jane G.; And Others

The American Institutes for Research (AIR) and the National Consumer Law Center (NCLC) studied consumer fraud and assessed possible intervention. Phase I produced an AIR description of the nature, scope, and characteristics of consumer fraud and an NCLC compilation of the laws and regulations which control it. In Phase II AIR developed…

29 CFR 453.12 - Meaning of fraud or dishonesty.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING REQUIREMENTS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Scope of the Bond § 453.12 Meaning of fraud or dishonesty. The term “fraud or...

29 CFR 453.12 - Meaning of fraud or dishonesty.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING REQUIREMENTS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Scope of the Bond § 453.12 Meaning of fraud or dishonesty. The term “fraud or...

29 CFR 453.12 - Meaning of fraud or dishonesty.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING REQUIREMENTS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Scope of the Bond § 453.12 Meaning of fraud or dishonesty. The term “fraud or...

29 CFR 453.12 - Meaning of fraud or dishonesty.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING REQUIREMENTS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Scope of the Bond § 453.12 Meaning of fraud or dishonesty. The term “fraud or...

29 CFR 453.12 - Meaning of fraud or dishonesty.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE BONDING REQUIREMENTS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Scope of the Bond § 453.12 Meaning of fraud or dishonesty. The term “fraud or...

32 CFR 516.60 - Procurement fraud and irregularities programs at MACOMs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 3 2011-07-01 2009-07-01 true Procurement fraud and irregularities programs at MACOMs. 516.60 Section 516.60 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption...

12 CFR 1805.812 - Fraud, waste and abuse.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Fraud, waste and abuse. 1805.812 Section 1805.812 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY..., waste and abuse. Any person who becomes aware of the existence or apparent existence of fraud, waste or...

45 CFR 79.44 - Right to administrative offset.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Right to administrative offset. 79.44 Section 79.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.44 Right to administrative offset. The amount of any penalty or assessment which has become...

45 CFR 79.17 - Rights of parties.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Rights of parties. 79.17 Section 79.17 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.17 Rights of parties. Except as otherwise limited by this part, all parties may— (a) Be accompanied...

45 CFR 79.17 - Rights of parties.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Rights of parties. 79.17 Section 79.17 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.17 Rights of parties. Except as otherwise limited by this part, all parties may— (a) Be accompanied...

45 CFR 79.44 - Right to administrative offset.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Right to administrative offset. 79.44 Section 79.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.44 Right to administrative offset. The amount of any penalty or assessment which has become...

45 CFR 79.44 - Right to administrative offset.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Right to administrative offset. 79.44 Section 79.44 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.44 Right to administrative offset. The amount of any penalty or assessment which has become...

45 CFR 79.17 - Rights of parties.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Rights of parties. 79.17 Section 79.17 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.17 Rights of parties. Except as otherwise limited by this part, all parties may— (a) Be accompanied...

49 CFR 31.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... loss; (7) The potential or actual impact of the misconduct upon national defense, public health or... assessments. 31.31 Section 31.31 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.31 Determining the amount of penalties and assessments. (a) In determining an appropriate...

40 CFR 27.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... assessments. 27.31 Section 27.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.31 Determining the amount of penalties and assessments. (a) In determining an...

40 CFR 27.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... assessments. 27.31 Section 27.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.31 Determining the amount of penalties and assessments. (a) In determining an...

45 CFR 79.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... assessments. 79.31 Section 79.31 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.31 Determining the amount of penalties and assessments. (a) In determining an appropriate amount of civil penalties and assessments, the ALJ and the authority head, upon...

49 CFR 31.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... loss; (7) The potential or actual impact of the misconduct upon national defense, public health or... assessments. 31.31 Section 31.31 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.31 Determining the amount of penalties and assessments. (a) In determining an appropriate...

49 CFR 31.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... loss; (7) The potential or actual impact of the misconduct upon national defense, public health or... assessments. 31.31 Section 31.31 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.31 Determining the amount of penalties and assessments. (a) In determining an appropriate...

40 CFR 27.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2014 CFR

2014-07-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... assessments. 27.31 Section 27.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.31 Determining the amount of penalties and assessments. (a) In determining an...

49 CFR 31.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... loss; (7) The potential or actual impact of the misconduct upon national defense, public health or... assessments. 31.31 Section 31.31 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.31 Determining the amount of penalties and assessments. (a) In determining an appropriate...

49 CFR 31.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... loss; (7) The potential or actual impact of the misconduct upon national defense, public health or... assessments. 31.31 Section 31.31 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.31 Determining the amount of penalties and assessments. (a) In determining an appropriate...

40 CFR 27.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... assessments. 27.31 Section 27.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.31 Determining the amount of penalties and assessments. (a) In determining an...

45 CFR 79.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... assessments. 79.31 Section 79.31 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.31 Determining the amount of penalties and assessments. (a) In determining an appropriate amount of civil penalties and assessments, the ALJ and the authority head, upon...

40 CFR 27.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2012 CFR

2012-07-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... assessments. 27.31 Section 27.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.31 Determining the amount of penalties and assessments. (a) In determining an...

45 CFR 79.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... assessments. 79.31 Section 79.31 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.31 Determining the amount of penalties and assessments. (a) In determining an appropriate amount of civil penalties and assessments, the ALJ and the authority head, upon...

45 CFR 79.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... assessments. 79.31 Section 79.31 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.31 Determining the amount of penalties and assessments. (a) In determining an appropriate amount of civil penalties and assessments, the ALJ and the authority head, upon...

45 CFR 79.23 - Subpoenas for attendance at hearing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Subpoenas for attendance at hearing. 79.23 Section 79.23 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.23 Subpoenas for attendance at hearing. (a) A party wishing to procure the...

45 CFR 79.46 - Compromise or settlement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Compromise or settlement. 79.46 Section 79.46 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.46 Compromise or settlement. (a) Parties may make offers of compromise or settlement at any...

45 CFR 79.28 - Motions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Motions. 79.28 Section 79.28 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.28 Motions. (a) Any application to the ALJ for an order or ruling shall be by motion. Motions shall state the...

45 CFR 79.33 - Witnesses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Witnesses. 79.33 Section 79.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.33 Witnesses. (a) Except as provided in paragraph (b) of this section, testimony at the hearing shall be given...

45 CFR 79.37 - Initial decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Initial decision. 79.37 Section 79.37 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.37 Initial decision. (a) The ALJ shall issue an initial decision based only on the record, which...

45 CFR 79.12 - Notice of hearing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Notice of hearing. 79.12 Section 79.12 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.12 Notice of hearing. (a) When the ALJ receives the complaint and answer, the ALJ shall promptly...

45 CFR 79.17 - Rights of parties.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Rights of parties. 79.17 Section 79.17 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.17 Rights of parties. Except as otherwise limited by this part, all parties may— (a) Be accompanied...

45 CFR 79.43 - Collection of civil penalties and assessments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Collection of civil penalties and assessments. 79.43 Section 79.43 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.43 Collection of civil penalties and assessments. Sections 3806 and 3808...

45 CFR 79.24 - Protective order.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Protective order. 79.24 Section 79.24 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.24 Protective order. (a) A party or a prospective witness or deponent may file a motion for a...

45 CFR 79.16 - Disqualification of reviewing official or ALJ.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Disqualification of reviewing official or ALJ. 79.16 Section 79.16 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.16 Disqualification of reviewing official or ALJ. (a) A reviewing...

45 CFR 79.35 - The record.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false The record. 79.35 Section 79.35 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.35 The record. (a) The hearing will be recorded and transcribed. Transcripts may be obtained following the...

45 CFR 79.14 - Separation of functions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Separation of functions. 79.14 Section 79.14 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL..., except as a witness or a representative in public proceedings; or (3) Make the collection of penalties...

45 CFR 79.7 - Complaint.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Complaint. 79.7 Section 79.7 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.7 Complaint. (a) On or after the date the Department of Justice approves the issuance of a complaint in accordance...

45 CFR 79.41 - Stay pending appeal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Stay pending appeal. 79.41 Section 79.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a...

45 CFR 79.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Definitions. 79.2 Section 79.2 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.2 Definitions. ALJ means an Administrative Law Judge in the authority appointed pursuant to 5 U.S.C. 3105 or...

45 CFR 79.9 - Answer.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Answer. 79.9 Section 79.9 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.9 Answer. (a) The defendant may request a hearing by filing an answer with the reviewing official within 30 days of...

45 CFR 79.15 - Ex parte contacts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Ex parte contacts. 79.15 Section 79.15 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.15 Ex parte contacts. No party or person (except employees of the ALJ's office) shall communciate in...

45 CFR 79.20 - Disclosure of documents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Disclosure of documents. 79.20 Section 79.20 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.20 Disclosure of documents. (a) Upon written request to the reviewing official, the defendant...

45 CFR 79.42 - Judicial review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Judicial review. 79.42 Section 79.42 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.42 Judicial review. Section 3805 of title 31, United States Code, authorizes judicial review by an...

45 CFR 79.6 - Prerequisites for issuing a complaint.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Prerequisites for issuing a complaint. 79.6 Section 79.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.6 Prerequisites for issuing a complaint. (a) The reviewing official may issue a...

45 CFR 79.29 - Sanctions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Sanctions. 79.29 Section 79.29 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.29 Sanctions. (a) The ALJ may sanction a person, including any party or representative, for— (1) Failing to comply...

45 CFR 79.44 - Right to administrative offset.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Right to administrative offset. 79.44 Section 79.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.44 Right to administrative offset. The amount of any penalty or assessment which has become...

45 CFR 79.38 - Reconsideration of initial decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reconsideration of initial decision. 79.38 Section 79.38 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.38 Reconsideration of initial decision. (a) Except as provided in paragraph (d) of...

45 CFR 79.34 - Evidence.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Evidence. 79.34 Section 79.34 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.34 Evidence. (a) The ALJ shall determine the admissibility of evidence. (b) Except as provided in this part, the...

45 CFR 79.47 - Limitations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Limitations. 79.47 Section 79.47 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.47 Limitations. (a) The notice of hearing with respect to a claim or statement must be served in the manner...

45 CFR 96.33 - Referral of cases to the Inspector General.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 96.33 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who have information indicating the commission or potential commission of fraud or other offenses against the United...

45 CFR 96.33 - Referral of cases to the Inspector General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who have information indicating the commission or potential commission of fraud or other offenses against the United...

45 CFR 96.33 - Referral of cases to the Inspector General.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who have information indicating the commission or potential commission of fraud or other offenses against the United...

45 CFR 96.33 - Referral of cases to the Inspector General.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who have information indicating the commission or potential commission of fraud or other offenses against the United...

45 CFR 96.33 - Referral of cases to the Inspector General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who have information indicating the commission or potential commission of fraud or other offenses against the United...

Catastrophic events and older adults.

PubMed

Cloyd, Elizabeth; Dyer, Carmel B

2010-12-01

The plight of older adults during catastrophic events is a societal concern. Older persons have an increased prevalence of cognitive disorders, chronic illnesses, and mobility problems that limit their ability to cope. These disorders may result in a lack of mental capacity and the ability to discern when they should evacuate or resolve problems encountered during a catastrophe. Some older persons may have limited transportation options, and many of the elderly survivors are at increased risk for abuse, neglect, and exploitation. Recommendations for future catastrophic events include the development of a federal tracking system for elders and other vulnerable adults, the designation of separate shelter areas for elders and other vulnerable adults, and involvement of gerontological professionals in all aspects of emergency preparedness and care delivery, including training of frontline workers. Preparation through preevent planning that includes region-specific social services, medical and public health resources, volunteers, and facilities for elders and vulnerable adults is critical. Elders need to be protected from abuse and fraud during catastrophic events. A public health triage system for elders and other vulnerable populations in pre- and postdisaster situations is useful, and disaster preparedness is paramount. Communities and members of safety and rescue teams must address ethical issues before an event. When older adults are involved, consideration needs to be given to triage decision making, transporting those who are immobile, the care of older adults who receive palliative care, and the equitable distribution of resources. Nurses are perfectly equipped with the skills, knowledge, and training needed to plan and implement disaster preparedness programs. In keeping with the tradition of Florence Nightingale, nurses can assume several crucial roles in disaster preparedness for older adults. Nurses possess the ability to participate and lead community policy development, serve on rescue teams, perform patient assessments, and deliver care. Nurses are crucial to well-planned and executed programs for catastrophic events that affect older adults. Also, all health care providers involved must be aware of the physical and psychological ramifications of disaster relief. The health and resilience of disaster-relief teams depend on paying attention to signs and symptoms of posttraumatic stress disorder and seeking appropriate treatment should it occur. Copyright © 2010 Elsevier Inc. All rights reserved.

E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.

PubMed

Lewis, Trevor; Synowiec, Christina; Lagomarsino, Gina; Schweitzer, Julian

2012-05-01

To describe how information communication technology (ICT) is being used by programmes that seek to improve private sector health financing and delivery in low- and middle-income countries, including the main uses of the technology and the types of technologies being used. In-country partners in 16 countries directly searched systematically for innovative health programmes and compiled profiles in the Center for Health Market Innovations' database. These data were supplemented through literature reviews and with self-reported data supplied by the programmes themselves. In many low- and middle-income countries, ICT is being increasingly employed for different purposes in various health-related areas. Of ICT-enabled health programmes, 42% use it to extend geographic access to health care, 38% to improve data management and 31% to facilitate communication between patients and physicians outside the physician's office. Other purposes include improving diagnosis and treatment (17%), mitigating fraud and abuse (8%) and streamlining financial transactions (4%). The most common devices used in technology-enabled programmes are phones and computers; 71% and 39% of programmes use them, respectively, and the most common applications are voice (34%), software (32%) and text messages (31%). Donors are the primary funders of 47% of ICT-based health programmes. Various types of ICT are being employed by private organizations to address key health system challenges. For successful implementation, however, more sustainable sources of funding, greater support for the adoption of new technologies and better ways of evaluating impact are required.

32 CFR 516.67 - Overseas cases of fraud or corruption.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Overseas cases of fraud or corruption. 516.67 Section 516.67 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.67 Overseas...

Playing the Ponies: A $5 Million Embezzlement Case

ERIC Educational Resources Information Center

Howe, Martha A.; Malgwi, Charles A.

2006-01-01

Fraud is a pervasive problem, and educating future business leaders, managers, and auditors about fraud is one way to attack the problem. This instructional fraud case chronicles the actual details surrounding a major embezzlement at a regional high school (RHS) that culminated in long federal and state prison sentences for the school's treasurer.…

13 CFR 142.8 - What happens if program fraud is suspected?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What happens if program fraud is suspected? 142.8 Section 142.8 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION PROGRAM FRAUD... demanded in the false claim or statement; (5) Any exculpatory or mitigating circumstances that may relate...

Reducing Fraudulent Financial Reporting: An Expanded Role for Business Education in the 1990s.

ERIC Educational Resources Information Center

Urbancic, Frank R.

1988-01-01

The author reports findings of the National Commission on Fraudulent Financial Reporting concerning the role of business education in reducing fraud in financial reporting. Issues covered include teaching financial regulations, developing skills needed to detect fraud, teaching ethical values, and preparing faculty to teach about financial fraud.…

45 CFR 681.5 - What happens if program fraud is suspected?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false What happens if program fraud is suspected? 681.5 Section 681.5 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... What happens if program fraud is suspected? (a) If the investigating official concludes that an action...

10 CFR 1015.103 - Antitrust, fraud, tax, interagency, transportation account audit, acquisition contract, and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... does not apply to tax debts. (c) Part 1015 does not apply to claims between Federal agencies. Federal... 10 Energy 4 2010-01-01 2010-01-01 false Antitrust, fraud, tax, interagency, transportation account... General § 1015.103 Antitrust, fraud, tax, interagency, transportation account audit, acquisition contract...

48 CFR 252.203-7004 - Display of fraud hotline poster(s).

Code of Federal Regulations, 2012 CFR

2012-10-01

... poster(s). 252.203-7004 Section 252.203-7004 Federal Acquisition Regulations System DEFENSE ACQUISITION... of Provisions And Clauses 252.203-7004 Display of fraud hotline poster(s). As prescribed in 203.1004(b)(2)(ii), use the following clause: Display of Fraud Hotline Poster(s) (SEP 2011) (a) Definition...

76 FR 57671 - Defense Federal Acquisition Regulation Supplement; Display of DoD Inspector General Fraud Hotline...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... General Fraud Hotline Posters AGENCY: Defense Acquisition Regulations System, Department of Defense (DoD... Regulation Supplement (DFARS) to require contractors to display the DoD fraud hotline poster in common work....203-14, Display of Hotline Poster(s). Government Accountability Office (GAO) Report GAO-09-591...

48 CFR 252.203-7004 - Display of fraud hotline poster(s).

Code of Federal Regulations, 2011 CFR

2011-10-01

... poster(s). 252.203-7004 Section 252.203-7004 Federal Acquisition Regulations System DEFENSE ACQUISITION... of Provisions And Clauses 252.203-7004 Display of fraud hotline poster(s). As prescribed in 203.1004(b)(2)(ii), use the following clause: Display of Fraud Hotline Poster(s) (Sep 2011) (a) Definition...

48 CFR 252.203-7004 - Display of fraud hotline poster(s).

Code of Federal Regulations, 2013 CFR

2013-10-01

... poster(s). 252.203-7004 Section 252.203-7004 Federal Acquisition Regulations System DEFENSE ACQUISITION... of Provisions And Clauses 252.203-7004 Display of fraud hotline poster(s). As prescribed in 203.1004(b)(2)(ii), use the following clause: Display of Fraud Hotline Poster(s) (DEC 2012) (a) Definition...

48 CFR 252.203-7004 - Display of fraud hotline poster(s).

Code of Federal Regulations, 2014 CFR

2014-10-01

... poster(s). 252.203-7004 Section 252.203-7004 Federal Acquisition Regulations System DEFENSE ACQUISITION... of Provisions And Clauses 252.203-7004 Display of fraud hotline poster(s). As prescribed in 203.1004(b)(2)(ii), use the following clause: Display of Fraud Hotline Poster(s) (DEC 2012) (a) Definition...

25 CFR 700.541 - Fraud or false statement in a Government matter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Fraud or false statement in a Government matter. 700.541... RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.541 Fraud or false statement in a Government..., applications for employment, personnel security forms, requests for travel reimbursement, client certification...

45 CFR 235.110 - Fraud.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Fraud. 235.110 Section 235.110 Public Welfare... PROGRAMS § 235.110 Fraud. State plan requirements: A State plan under title I, IV-A, X, XIV, or XVI of the Social Security Act must provide: (a) That the State agency will establish and maintain: (1) Methods and...

42 CFR 1007.3 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... STATE MEDICAID FRAUD CONTROL UNITS § 1007.3 Scope and purpose. This part implements sections 1903(a)(6), 1903(b)(3), and 1903(q) of the Social Security Act, as amended by the Medicare-Medicaid Anti-Fraud and... costs of establishing and operating a State Medicaid fraud control unit, as defined by the statute, for...

7 CFR 762.103 - Full faith and credit.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.103 Full faith and credit. (a) Fraud and... States. The Agency may contest the guarantee only in cases of fraud or misrepresentation by a lender or holder, in which: (1) The lender or holder had actual knowledge of the fraud or misrepresentation at the...

Special Fraud Alert for Schools, Lenders, and Guarantee Agencies.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

Guidelines to prevent fraud and abuse in the government's student aid programs are presented for schools, lenders, and guarantee agencies. Student aid fraud is defined as intentional wrongful obtaining of student financial assistance (SFA) benefits through deceptive means. It is noted that falsification of eligibility is the most common form of…

26 CFR 301.6110-1 - Public inspection of written determinations and background file documents.

Code of Federal Regulations, 2011 CFR

2011-04-01

... section, relating to technical advice memoranda involving civil fraud and criminal investigations, and... section 6110(d)(3) and (f)(4). (2) Technical advice memoranda involving civil fraud and criminal... § 301.6110-2(f) involving any matter that is the subject of a civil fraud or criminal investigation, a...

45 CFR 681.5 - What happens if program fraud is suspected?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 3 2011-10-01 2011-10-01 false What happens if program fraud is suspected? 681.5 Section 681.5 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... What happens if program fraud is suspected? (a) If the investigating official concludes that an action...

45 CFR 681.5 - What happens if program fraud is suspected?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 3 2014-10-01 2014-10-01 false What happens if program fraud is suspected? 681.5 Section 681.5 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... What happens if program fraud is suspected? (a) If the investigating official concludes that an action...

45 CFR 681.5 - What happens if program fraud is suspected?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 3 2012-10-01 2012-10-01 false What happens if program fraud is suspected? 681.5 Section 681.5 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... What happens if program fraud is suspected? (a) If the investigating official concludes that an action...

45 CFR 681.5 - What happens if program fraud is suspected?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 3 2013-10-01 2013-10-01 false What happens if program fraud is suspected? 681.5 Section 681.5 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... What happens if program fraud is suspected? (a) If the investigating official concludes that an action...

76 FR 40223 - Extension of Temporary Exemptions for Eligible Credit Default Swaps To Facilitate Operation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

...-fraud provisions, as well as exempt these security-based swaps from Exchange Act registration... interest involving security-based swaps.\\31\\ We have also proposed anti-fraud and anti-manipulation rules... Against Fraud, Manipulation, and Deception in Connection with Security-Based Swaps, Release No. 34-63236...

32 CFR 516.68 - Program Fraud Civil Remedies Act (PFCRA).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 3 2011-07-01 2009-07-01 true Program Fraud Civil Remedies Act (PFCRA). 516.68 Section 516.68 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.68 Program...

A guide to organizing joint ventures with physicians.

PubMed

Peters, G R

1986-12-01

Catholic health care facilities must consider the business and legal risks, canon law, and other constraints when planning a joint venture with physicians. Participants should first establish goals and compatibility, then determine the venture's type (property, service), form ("true," lease, contract), and structure (corporation, partnership, joint property ownership, trust). The administrator must decide whether the facility will participate directly in the venture or form a separate organization. Participants must determine their relationships with the venture, choosing among many options. The administrator should consider whether a venture raises any canon law issues, especially regarding ecclesiastical and secular assets, approval by the local bishop or Holy See, and need for consultation. Other pertinent legal issues include: Fraud and abuse. The venture should not appear as compensation to induce referrals. Physician referrals. Many states prohibit or restrict referrals by physician participants. Antitrust law. Participants may be liable for actions constituting on antitrust violation. Securities low. Organizers must clarify Securities and Exchange Commission registration exemptions and observe state "blue sky" laws. Tax issues. Catholic health care facilities must consider such factors as tax-exempt status, unrelated business income, taxable subsidiaries, and public charity status. Other considerations include tax ramifications for physicians; tax shelter registration; certificate of need (CON), licensing, and building standards; effects on reimbursement and pension plans; organizational and bond documents; corporate medical practice and fee-splitting questions; and labor and contractual issues.

Ambulatory surgery centers and interventional techniques: a look at long-term survival.

PubMed

Manchikanti, Laxmaiah; Parr, Allan T; Singh, Vijay; Fellows, Bert

2011-01-01

With health care expenditures skyrocketing, coupled with pervasive quality deficits, pressures to provide better and more proficient care continue to shape the landscape of the U.S. health care system. Payers, both federal and private, have laid out several initiatives designed to curtail costs, including value-based reimbursement programs, cost-shifting expenses to the consumer, reducing reimbursements for physicians, steering health care to more efficient settings, and finally affordable health care reform. Consequently, one of the major aspects in the expansion of health care for improving quality and reducing the costs is surgical services. Nearly 57 million outpatient procedures are performed annually in the United States, 14 million of which occur in elderly patients. Increasing use of these minor, yet common, procedures contributes to rising health care expenditures. Once exclusive within hospitals, more and more outpatient procedures are being performed in freestanding ambulatory surgery centers (ASCs), physician offices, visits to which have increased over 300% during the past decade. Concurrent with this growing demand, the number of ASCs has more than doubled since the 1990s, with more than 5,000 facilities currently in operation nationwide. Further, total surgical center ASC payments have increased from $1.2 billion in 1999 to $3.2 billion in 2009, a 167% increase. On the same lines, growth and expenditures for hospital outpatient department (HOPD) services and office procedures also have been evident at similar levels. Recent surveys have illustrated on overall annual growth per capita in Medicare allowed ASC services of pain management of 23%, with 27% growth seen in ASCs and 16% of the growth seen in HOPD. Further, the proportion of interventional pain management which was 4% of Medicare ASC spending in 2000 has increase to 10% in 2007. Thus, interventional pain management as an evolving specialty is one of the most commonly performed procedures in ASC settings apart from HOPDs and well-equipped offices. In June 1998, the Health Care Financing Administration (HCFA), proposed an ASC rule in which at least 60% of interventional procedures were eliminated from ASCs and the remaining 40% faced substantial cuts in payments. Following the publication of this rule, based on public comments and demand, Congress intervened and delayed implementation of the rule for several years. The Centers for Medicare and Medicaid Services (CMS) published its proposed outpatient prospective system for ASCs in 2006, setting ASC payments at 62% of HOPD payments. Following multiple changes, the rule was incorporated with a 4-year transition formula which ended in 2010, with full effect taking effect in 2011 with ASCs reimbursed at 57% of HOPD payments. Thus, the landscape of interventional pain management in ambulatory surgery centers has been constantly changing with declining reimbursements, issues of fraud and abuse, and ever-increasing regulations.

Training US health care professionals on human trafficking: where do we go from here?

PubMed Central

Powell, Clydette; Dickins, Kirsten; Stoklosa, Hanni

2017-01-01

ABSTRACT Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in HT education of HCPs in the US. This mixed-method study had two components. The first component consisted of structured interviews with experts in human trafficking HCP education. The second portion of the study involved an analysis of data from HCP calls to the National Human Trafficking Resource Center (NHTRC). The interviews captured trainer-specific data on types of HT training, duration and frequency, key content areas, presence of evaluation approaches and indicators, as well as an assessment of barriers and strengths in HT training for HCP. NHTRC call database analysis demonstrated increasing trends since 2008 in calls by HCPs. Overall findings revealed the need for standardization of HT training content to assure correct information, trauma-informed and patient-centered care, and consistent messaging for HCPs. Evaluation metrics for HT training need to be developed to demonstrate behavior change and impact on service delivery and patient-centered outcomes for HT victims, according to our proposed adapted Kirkpatrick’s Pyramid model. HT training and evaluation would benefit from an agency or institution at the national level to provide consistency and standardization of HT training content as well as to guide a process that would develop metrics for evaluation and the building of an evidence base. Abbreviations: AAP: American Academy of Pediatrics; ACF: Administration for Children and Families; CME: Continuing medical education; ED: Emergency department; HCP: Health care professional; HEAL: Health, Education, Advocacy, and Linkage; HHS: United States Department of Health and Human Services; HT: Human trafficking; IOM: United States Institute of Medicine; MH: Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop, Observe, Ask, and Respond to Health and Wellness Training PMID:28178913

Training US health care professionals on human trafficking: where do we go from here?

PubMed

Powell, Clydette; Dickins, Kirsten; Stoklosa, Hanni

2017-01-01

Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in HT education of HCPs in the US. This mixed-method study had two components. The first component consisted of structured interviews with experts in human trafficking HCP education. The second portion of the study involved an analysis of data from HCP calls to the National Human Trafficking Resource Center (NHTRC). The interviews captured trainer-specific data on types of HT training, duration and frequency, key content areas, presence of evaluation approaches and indicators, as well as an assessment of barriers and strengths in HT training for HCP. NHTRC call database analysis demonstrated increasing trends since 2008 in calls by HCPs. Overall findings revealed the need for standardization of HT training content to assure correct information, trauma-informed and patient-centered care, and consistent messaging for HCPs. Evaluation metrics for HT training need to be developed to demonstrate behavior change and impact on service delivery and patient-centered outcomes for HT victims, according to our proposed adapted Kirkpatrick's Pyramid model. HT training and evaluation would benefit from an agency or institution at the national level to provide consistency and standardization of HT training content as well as to guide a process that would develop metrics for evaluation and the building of an evidence base. AAP: American Academy of Pediatrics; ACF: Administration for Children and Families; CME: Continuing medical education; ED: Emergency department; HCP: Health care professional; HEAL: Health, Education, Advocacy, and Linkage; HHS: United States Department of Health and Human Services; HT: Human trafficking; IOM: United States Institute of Medicine; MH: Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop, Observe, Ask, and Respond to Health and Wellness Training.

Employee theft and fraud: bigger than ever and getting worse.

PubMed

2001-02-01

Fraud examiners and investigators say that employee theft is out of control, citing recent U.S. Chamber of Commerce figures that employees steal approximately $400 billion from businesses each year and an Ernst & Young survey showing that nearly 90% of organizations countrywide experienced some type of fraud in the 12 months prior to the survey. An additional undetermined amount is being reported lost because of external fraud committed by customers, vendors, and others having contact with a company or institution. Fraud experts interviewed for this report note that all sectors are targets--including retailers, hospitals and healthcare, the hotel industry, schools, and college campuses. In this report, we'll present the how's and whys of this development and also describe what one medical center is doing to stop thefts of medical equipment and computers.

The Pasquich affair

NASA Astrophysics Data System (ADS)

Patkós, Laszló

The history of scientific research and particularly the history of astronomy is sometimes shaded by some people who tried to make forging and fraud instead of working hard. There are well-known sad stories, but there are also some with a positive end. One of them is the forging charge against Johann Pasquich, the director of St. Gellert Hill Observatory in Buda. He measured positions of the bright comet of 1821 and published his results in Astronomische Nachrichten Vol. 1, No. 2, 1821. His assistant Daniel Kmeth accused him with fraud, first in a letter written to the editor of Astronomische Nachrichten, Ch. Schumacher. Despite Schumacher's doubts, Kmeth repeated his accusations in the prestigious Hungarian periodical Tudományos Gyüjtemény, and moreover in Zach's Correspondance Astronomique. As the result of a long and careful investigation, Pasquich was discharged. The calculations which proved that Pasquich was right were carried out by the most famous scientists of the era: Ch. Schumacher, C.F. Gauss, J.F. Encke, W. Olbers and F.W. Bessel

Data fraud in clinical trials

PubMed Central

George, Stephen L; Buyse, Marc

2015-01-01

Highly publicized cases of fabrication or falsification of data in clinical trials have occurred in recent years and it is likely that there are additional undetected or unreported cases. We review the available evidence on the incidence of data fraud in clinical trials, describe several prominent cases, present information on motivation and contributing factors and discuss cost-effective ways of early detection of data fraud as part of routine central statistical monitoring of data quality. Adoption of these clinical trial monitoring procedures can identify potential data fraud not detected by conventional on-site monitoring and can improve overall data quality. PMID:25729561

The effects of loneliness on telemarketing fraud vulnerability among older adults.

PubMed

Alves, Linda M; Wilson, Steve R

2008-01-01

Older adults are disproportionately affected by telemarketing fraud, especially those who are socially isolated. Twenty-eight older adult telemarketing fraud victims completed a questionnaire assessing loneliness and other variables related to telemarketing fraud vulnerability. Victims tended to be male, divorced/separated, and college-educated, between ages of 60 and 70. Age and marital status were significantly associated with loneliness. This study is an important first step for additional research in this area and may enhance the prevention and intervention efforts of social service providers who work with older adults who may be most vulnerable.

Blood recipient unable to recover damages based on fraud.

PubMed

1995-05-05

A court ruled that [name removed] is unable to sue for fraud after acquiring HIV through a blood transfusion in 1982. [Name removed], who sued the hospital, her cardiologist, and two physicians, claimed she did not learn she had received a blood transfusion until after she was diagnosed with AIDS. She tested positive for HIV antibodies in March 1992 and was diagnosed with AIDS. The Supreme Court said a cause of action for actual fraud must be filed within six years from the date of the fraudulent act or two years from the date the plaintiff discovered the fraud.

The Role of Cognition, Personality, and Trust in Fraud Victimization in Older Adults

PubMed Central

Judges, Rebecca A.; Gallant, Sara N.; Yang, Lixia; Lee, Kang

2017-01-01

Older adults are more at risk to become a victim of consumer fraud than any other type of crime (Carcach et al., 2001) but the research on the psychological profiles of senior fraud victims is lacking. To bridge this significant gap, we surveyed 151 (120 female, 111 Caucasian) community-dwelling older adults in Southern Ontario between 60 and 90 years of age about their experiences with fraud. Participants had not been diagnosed with cognitive impairment or a neurological disorder by their doctor and looked after their own finances. We assessed their self-reported cognitive abilities using the MASQ, personality on the 60-item HEXACO Personality Inventory, and trust tendencies using a scale from the World Values Survey. There were no demographic differences between victims and non-victims. We found that victims exhibit lower levels of cognitive ability, lower honesty-humility, and lower conscientiousness than non-victims. Victims and non-victims did not differ in reported levels of interpersonal trust. Subsequent regression analyses showed that cognition is an important component in victimization over and above other social factors. The present findings suggest that fraud prevention programs should focus on improving adults’ overall cognitive functioning. Further investigation is needed to understand how age-related cognitive changes affect vulnerability to fraud and which cognitive processes are most important for preventing fraud victimization. PMID:28450847

13 CFR 142.2 - What kind of conduct will result in program fraud enforcement?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What kind of conduct will result in program fraud enforcement? 142.2 Section 142.2 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Overview and Definitions § 142.2 What kind of conduct...

Data Analytics in Procurement Fraud Prevention

DTIC Science & Technology

2014-05-30

Certified Fraud Examiners CAC common access card COR contracting officer’s representative CPAR Contractor Performance Assessment Reporting System DCAA...using analytics to predict patterns occurring in known credit card fraud investigations to prevent future schemes before they happen. The goal of...or iTunes . 4. Distributional Analytics Distributional analytics are used to detect anomalies within data. Through the use of distributional

31 CFR 900.3 - Antitrust, fraud, and tax and interagency claims excluded.

Code of Federal Regulations, 2010 CFR

2010-07-01

... apply to tax debts. (c) Parts 900-904 of this chapter do not apply to claims between Federal agencies... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Antitrust, fraud, and tax and...) SCOPE OF STANDARDS § 900.3 Antitrust, fraud, and tax and interagency claims excluded. (a) The standards...

17 CFR 240.15c1-2 - Fraud and misrepresentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Fraud and misrepresentation. 240.15c1-2 Section 240.15c1-2 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... Securities Exchange Act of 1934 Rules Relating to Over-The-Counter Markets § 240.15c1-2 Fraud and...

17 CFR 39.7 - Fraud in connection with the clearing of transactions on a derivatives clearing organization.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Fraud in connection with the clearing of transactions on a derivatives clearing organization. 39.7 Section 39.7 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION DERIVATIVES CLEARING ORGANIZATIONS § 39.7 Fraud in connection...

43 CFR 20.510 - Fraud or false statements in a Government matter.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Fraud or false statements in a Government matter. 20.510 Section 20.510 Public Lands: Interior Office of the Secretary of the Interior EMPLOYEE RESPONSIBILITIES AND CONDUCT Other Employee Conduct Provisions § 20.510 Fraud or false statements in a Government...

43 CFR 20.510 - Fraud or false statements in a Government matter.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Fraud or false statements in a Government matter. 20.510 Section 20.510 Public Lands: Interior Office of the Secretary of the Interior EMPLOYEE RESPONSIBILITIES AND CONDUCT Other Employee Conduct Provisions § 20.510 Fraud or false statements in a Government...

Criminal Intent with Property: A Study of Real Estate Fraud Prediction and Detection

ERIC Educational Resources Information Center

Blackman, David H.

2013-01-01

The large number of real estate transactions across the United States, combined with closing process complexity, creates extremely large data sets that conceal anomalies indicative of fraud. The quantitative amount of damage due to fraud is immeasurable to the lives of individuals who are victims, not to mention the financial impact to…

HealthSouth's most wanted. Founder and former chairman and CEO Richard Scrushy is indicted for 85 counts of conspiracy, fraud and money laundering.

PubMed

Piotrowski, Julie

2003-11-10

Wake-up call for the industry or an isolated case of corporate chicanery? Healthcare experts are divided on the import of Richard Scrushy's indictment on 85 counts last week in connection with the financial scandal at HealthSouth Corp. The indictment alleges the company founder relied on electronic and telephone surveillance, threats and intimidation to control his accomplices.

TANTAMOUNT TO FRAUD?: EXPLORING NON-DISCLOSURE OF GENETIC INFORMATION IN LIFE INSURANCE APPLICATIONS AS GROUNDS FOR POLICY RESCISSION.

PubMed

Prince, Anya E R

2016-01-01

Many genetic counselors recommend that individuals secure desired insurance policies, such as life insurance, prior to undergoing predictive genetic testing. It has been argued, however, that this practice is "tantamount to fraud" and that failure to disclose genetic test results, or conspiring to secure a policy before testing, opens an individual up to legal recourse. This debate traps affected individuals in a Catch-22. If they apply for life insurance and disclose a genetic test result, they may be denied. If they apply without disclosing the information, they may have committed fraud. The consequences of life insurance fraud are significant: If fraud is found on an application, a life insurer can rescind the policy, in some cases even after the individual has passed away. Such a rescission could leave family members or beneficiaries without the benefits of the life insurance policy payment after the individual's death and place them in in economic difficulty. Although it is clear that lying in response to a direct question about genetic testing would be tantamount to fraud, few, if any, life insurance applications currently include broad questions about genetic testing. This paper investigates whether non-disclosure of unasked for genetic information constitutes fraud and explores varying types of insurance questions that could conceivably be interpreted as seeking genetic information. Life insurance applicants generally have no duty to disclose unasked for information, including genetic information, on an application. However, given the complexities of genetic information, individuals may be exposed to fraud and rescission of their life insurance policy despite honest attempts to truthfully and completely answer all application questions.

15 CFR 25.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... and assessments. 25.31 Section 25.31 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.31 Determining the amount of penalties and assessments. (a) In...

15 CFR 25.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... and assessments. 25.31 Section 25.31 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.31 Determining the amount of penalties and assessments. (a) In...

15 CFR 25.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... and assessments. 25.31 Section 25.31 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.31 Determining the amount of penalties and assessments. (a) In...

15 CFR 25.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... and assessments. 25.31 Section 25.31 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.31 Determining the amount of penalties and assessments. (a) In...

15 CFR 25.31 - Determining the amount of penalties and assessments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... impact of the misconduct upon national defense, public health or safety, or public confidence in the... and assessments. 25.31 Section 25.31 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.31 Determining the amount of penalties and assessments. (a) In...

45 CFR 79.22 - Exchange of witness lists, statements and exhibits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Exchange of witness lists, statements and exhibits. 79.22 Section 79.22 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.22 Exchange of witness lists, statements and exhibits. (a) At least 15...

45 CFR 79.8 - Service of complaint.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Service of complaint. 79.8 Section 79.8 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.8 Service of complaint. (a) Service of a complaint must be made by certified or registered mail or by...

45 CFR 79.30 - The hearing and burden of proof.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false The hearing and burden of proof. 79.30 Section 79.30 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL... by a preponderance of the evidence. (d) The hearing shall be open to the public unless otherwise...

45 CFR 79.3 - Basis for civil penalties and assessments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Basis for civil penalties and assessments. 79.3 Section 79.3 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.3 Basis for civil penalties and assessments. (a) Claims. (1) Except as provided in...

45 CFR 79.25 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Fees. 79.25 Section 79.25 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.25 Fees. The party requesting a subpoena shall pay the cost of the fees and mileage of any witness subpoenaed in the...

45 CFR 79.26 - Form, filing and service of papers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Form, filing and service of papers. 79.26 Section 79.26 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.26 Form, filing and service of papers. (a) Form. (1) Documents filed with the ALJ...

45 CFR 79.36 - Post-hearing briefs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Post-hearing briefs. 79.36 Section 79.36 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.36 Post-hearing briefs. The ALJ may require the parties to file post-hearing briefs. In any event...

45 CFR 79.39 - Appeal to authority head.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Appeal to authority head. 79.39 Section 79.39 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.39 Appeal to authority head. (a) Any defendant who has filed a timely answer and who is...

45 CFR 79.5 - Review by the reviewing official.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Review by the reviewing official. 79.5 Section 79.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.5 Review by the reviewing official. (a) If, based on the report of the investigating official...

45 CFR 79.45 - Deposit in Treasury of United States.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Deposit in Treasury of United States. 79.45 Section 79.45 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.45 Deposit in Treasury of United States. All amounts collected pursuant to this part...

45 CFR 79.18 - Authority of the ALJ.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Authority of the ALJ. 79.18 Section 79.18 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.18 Authority of the ALJ. (a) The ALJ shall conduct a fair and impartial hearing, avoid delay...

45 CFR 79.13 - Parties to the hearing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Parties to the hearing. 79.13 Section 79.13 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.13 Parties to the hearing. (a) The parities to the hearing shall be the defendant and the authority...

45 CFR 79.32 - Location of hearing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Location of hearing. 79.32 Section 79.32 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.32 Location of hearing. (a) The hearing may be held— (1) In any judicial district of the United...

45 CFR 79.27 - Computation of time.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Computation of time. 79.27 Section 79.27 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.27 Computation of time. (a) In computing any period of time under this part or in an order issued...

Field experiment estimate of electoral fraud in Russian parliamentary elections

PubMed Central

Enikolopov, Ruben; Korovkin, Vasily; Petrova, Maria; Sonin, Konstantin; Zakharov, Alexei

2013-01-01

Electoral fraud is a widespread phenomenon, especially outside the developed world. Despite abundant qualitative and anecdotal evidence on its existence from around the world, there is very limited quantitative evidence on the extent of electoral fraud. We exploit random assignment of independent observers to 156 of 3,164 polling stations in the city of Moscow to estimate the effect of electoral fraud on the outcome of the Russian parliamentary elections held on December 4, 2011. We estimate the actual share of votes for the incumbent United Russia party to be at least 11 percentage points lower than the official count (36% instead of 47%). Our results suggest that the extent of the fraud was sufficient to have had a substantial impact on the outcome of the elections; they also confirm that the presence of observers is an important factor in ensuring the integrity of the procedure. PMID:23267093

Individual and Institutional Liability of Researchers in the Case of Scientific Fraud: Values and Ethics

ERIC Educational Resources Information Center

Baier, Eric; Dupraz, Laure

2007-01-01

How have university institutions generally tackled the fight against scientific fraud? We intend to throw light on the very process of public disclosure of scientific fraud, as it has transformed in the last 30 years within the framework of scientific research institutions. By focusing our analysis on the "denunciation process", we intend to refer…

38 CFR 1.902 - Antitrust, fraud, and tax and interagency claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

....900 through 1.953 do not apply to tax debts. (c) Sections 1.900 through 1.953 do not apply to claims... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Antitrust, fraud, and tax... Collection Effort, and Referral of Civil Claims for Money Or Property § 1.902 Antitrust, fraud, and tax and...

41 CFR 105-55.003 - Antitrust, fraud, tax, interagency claims, and claims over $100,000 excluded.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) This part does not apply to tax debts. (c) This part does not apply to claims between GSA and other... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Antitrust, fraud, tax... § 105-55.003 Antitrust, fraud, tax, interagency claims, and claims over $100,000 excluded. (a) The...

Training for Success: A Comparison of Anti-Fraud Knowledge Competencies

DTIC Science & Technology

2014-12-01

fraud, money laundering , and tax fraud. The section on punishing offenders contains two competencies: criminal prosecutions and the civil justice...investigations (Kittay, 2011). Money laundering investigations focus on the various methods individuals use to conceal proceeds earned from criminal ...Chartered Accowltants Cet·tified Anti - Money CAMS The Association of Cettified Laundering Specialist Anti - Money Latmdering Specialists Certified

17 CFR 1.1 - Fraud in or in connection with transactions in foreign currency subject to the Commodity Exchange...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Fraud in or in connection with... Securities Exchanges COMMODITY FUTURES TRADING COMMISSION GENERAL REGULATIONS UNDER THE COMMODITY EXCHANGE ACT Definitions § 1.1 Fraud in or in connection with transactions in foreign currency subject to the...

Early Detection of Online Auction Opportunistic Sellers through the Use of Negative-Positive Feedback

ERIC Educational Resources Information Center

Reinert, Gregory J.

2010-01-01

Apparently fraud is a growth industry. The monetary losses from Internet fraud have increased every year since first officially reported by the Internet Crime Complaint Center (IC3) in 2000. Prior research studies and third-party reports of fraud show rates substantially higher than eBay's reported negative feedback rate of less than 1%. The…

Contracting Processes, Internal Controls, and Procurement Fraud: A Knowledge Assessment

DTIC Science & Technology

2015-04-30

ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = Contracting Processes, Internal Controls, and Procurement Fraud: A Knowledge...DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Contracting Processes, Internal Controls, and Procurement Fraud: A Knowledge...capable processes, and effective internal controls result in the DoD having a higher level of vulnerability for procurement fraud (Rendon & Rendon, in

Protecting your practice.

PubMed

Kerr, Joseph

2015-01-01

Dentists have much invested in their practices. They need to protect their practices from fraud and noncompliance. The author provides practical suggestions for how to significantly reduce the risk of fraud and theft in the practice without disrupting day-to-day operations. By adhering to nonintrusive policy and procedure changes, dental practice owners can reduce inherent risks of fraud and theft, while increasing financial and human resource knowledge regarding their practice. Practice owners with the appropriate policies and procedures benefit from significantly lower risk of loss from fraud and theft. Furthermore, they have a better understanding of their practice's finances and human resources. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Shedding light on food fraud: spectrophotometric and spectroscopic methods as a tool against economically motivated adulteration of food

NASA Astrophysics Data System (ADS)

Petronijević, R. B.; Velebit, B.; Baltić, T.

2017-09-01

Intentional modification of food or substitution of food ingredients with the aim of gaining profit is food fraud or economically motivated adulteration (EMA). EMA appeared in the food supply chain, and following the global expansion of the food market, has become a world-scale problem for the global economy. Food frauds have involved oils, milk and meat products, infant formula, honey, juices, spices, etc. New legislation was enacted in the last decade in order to fight EMA. Effective analytical methods for food fraud detection are few and still in development. The majority of the methods in common use today for EMA detection are time consuming and inappropriate for use on the production line or out of the laboratory. The next step in the evolution of analytical techniques to combat food fraud is development of fast, accurate methods applicable using portable or handheld devices. Spectrophotometric and spectroscopic methods combined with chemometric analysis, and perhaps in combination with other rapid physico-chemical techniques, could be the answer. This review discusses some analytical techniques based on spectrophotometry and spectroscopy, which are used to reveal food fraud and EMA.

From Spin to Swindle: Identifying Falsification in Financial Text.

PubMed

Minhas, Saliha; Hussain, Amir

Despite legislative attempts to curtail financial statement fraud, it continues unabated. This study makes a renewed attempt to aid in detecting this misconduct using linguistic analysis with data mining on narrative sections of annual reports/10-K form. Different from the features used in similar research, this paper extracts three distinct sets of features from a newly constructed corpus of narratives (408 annual reports/10-K, 6.5 million words) from fraud and non-fraud firms. Separately each of these three sets of features is put through a suite of classification algorithms, to determine classifier performance in this binary fraud/non-fraud discrimination task. From the results produced, there is a clear indication that the language deployed by management engaged in wilful falsification of firm performance is discernibly different from truth-tellers. For the first time, this new interdisciplinary research extracts features for readability at a much deeper level, attempts to draw out collocations using n -grams and measures tone using appropriate financial dictionaries. This linguistic analysis with machine learning-driven data mining approach to fraud detection could be used by auditors in assessing financial reporting of firms and early detection of possible misdemeanours.

Risk Factors of Occupational Fraud: A Study of Member Institutions of the National Association of Independent Colleges and Universities

ERIC Educational Resources Information Center

Ten Napel, Karmen

2013-01-01

Available data indicate that colleges and universities have experienced an unexpected rise in occupational fraud over the past two decades. In order to mitigate the risk of fraud, these institutions must be proactive and have strong internal controls and policies. The purpose of this study was to examine the current controls in place at Midwest…

Reducing Homeland Insecurities: Ending Abuse of the Asylum and Credible Fear Program

DTIC Science & Technology

2015-03-01

Operations FDNS Fraud Detection and National Security FEMA Federal Emergency Management Agency FY Fiscal Year GAO Government Accounting...file applications. A 2002 Government Accounting Office (GAO) study on benefit fraud found that fraud was pervasive and routinely used in furtherance... Government Accountability Office, 2002), http://www.gao.gov/assets/240/233515.pdf. 7 Mark Motivans, Immigration Offenders in the Federal Justice

Fraud and Corruption Control at Education System Level: A Case Study of the Victorian Department of Education and Early Childhood Development in Australia

ERIC Educational Resources Information Center

Bandaranayake, Bandara

2014-01-01

This case describes the implementation of a fraud and corruption control policy initiative within the Victorian Department of Education and Early Childhood Development (the Department) in Australia. The policy initiative was administered and carried out by a small team of fraud control officials, including the author of this article, in the…

"Done more for me in a fortnight than anybody done in all me life." How welfare rights advice can help people with cancer.

PubMed

Moffatt, Suzanne; Noble, Emma; Exley, Catherine

2010-09-03

In the UK many people with cancer and their carers do not have easy access to the welfare benefits to which they are entitled adding further strain to the process of dealing with cancer. It is estimated that nine out of ten cancer patients' households experience loss of income as a direct result of cancer, which, due to its socio-economic patterning disproportionately affects those most likely to be financially disadvantaged. In the UK proactive welfare rights advice services accessed via health care settings significantly increase benefit entitlement among people with health problems and this paper reports on a qualitative study examining the impact of a welfare rights advice service specifically designed for people affected by cancer and their carers in County Durham, North East England (UK). Twenty two men and women with cancer or caring for someone with cancer who were recipients of welfare rights advice aged between 35 and 83 were recruited from a variety of health care and community settings. Semi-structured interviews were undertaken and analysed using the Framework method. Most of the participants experienced financial strain following their cancer diagnosis. Participants accessed the welfare rights service in a variety of ways, but mainly through referral by other professionals. The additional income generated by successful benefit claims was used in a number of ways and included offsetting additional costs associated with cancer and lessening the impact of loss of earnings. Overall, receiving welfare rights advice eased feelings of stress over financial issues at a time when participants were concerned about dealing with the impact of cancer. Lack of knowledge about benefit entitlements was the main barrier to accessing benefits, and this outweighed attitudinal factors such as stigma and concerns about benefit fraud. Financial strain resulting from a cancer diagnosis is compounded in the UK by lack of easy access to information about benefit entitlements and assistance to claim. Proactive welfare rights advice services, working closely with health and social care professionals can assist with the practical demands that arise from dealing with the illness and should be considered an important part of a holistic approach to cancer treatment.

Misconduct accounts for the majority of retracted scientific publications

PubMed Central

Fang, Ferric C.; Steen, R. Grant; Casadevall, Arturo

2012-01-01

A detailed review of all 2,047 biomedical and life-science research articles indexed by PubMed as retracted on May 3, 2012 revealed that only 21.3% of retractions were attributable to error. In contrast, 67.4% of retractions were attributable to misconduct, including fraud or suspected fraud (43.4%), duplicate publication (14.2%), and plagiarism (9.8%). Incomplete, uninformative or misleading retraction announcements have led to a previous underestimation of the role of fraud in the ongoing retraction epidemic. The percentage of scientific articles retracted because of fraud has increased ∼10-fold since 1975. Retractions exhibit distinctive temporal and geographic patterns that may reveal underlying causes. PMID:23027971

An Evaluation of the Effectiveness of Policy Communication in the Professional Development Centre's Training Programs.

ERIC Educational Resources Information Center

Rudasill, Susann E.

In the face of rising juvenile violent crime rates and media talk of waste, abuse, fraud, and ineffectiveness within the Florida Department of Health and Rehabilitative Services (HRS), the state recommended the adoption of a family-focused approach in client intervention strategy. The Florida Atlantic University Professional Development Centre…

45 CFR 79.10 - Default upon failure to file an answer.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Default upon failure to file an answer. 79.10 Section 79.10 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.10 Default upon failure to file an answer. (a) If the defendant does not file an...

45 CFR 79.11 - Referral of complaint and answer to the ALJ.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of complaint and answer to the ALJ. 79.11 Section 79.11 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the...

45 CFR 79.40 - Stays ordered by the Department of Justice.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Stays ordered by the Department of Justice. 79.40 Section 79.40 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.40 Stays ordered by the Department of Justice. If at any time the Attorney General...

Line-scan macro-scale Raman chemical imaging for authentication of powdered foods and ingredients

USDA-ARS?s Scientific Manuscript database

Adulteration and fraud for powdered foods and ingredients are rising food safety risks that threaten consumers’ health. In this study, a newly developed line-scan macro-scale Raman imaging system using a 5 W 785 nm line laser as excitation source was used to authenticate the food powders. The system...

42 CFR 480.137 - Disclosure to Federal and State enforcement agencies responsible for the investigation or...

Code of Federal Regulations, 2010 CFR

2010-10-01

... agencies responsible for the investigation or identification of fraud or abuse of the Medicare or Medicaid programs. 480.137 Section 480.137 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Medicare or Medicaid programs. (a) Required disclosure. Except as specified in §§ 480.139(a) and 480.140...

Validation of internet-based self-reported anthropometric, demographic data and participant identity in the Food4Me study

USDA-ARS?s Scientific Manuscript database

BACKGROUND In e-health intervention studies, there are concerns about the reliability of internet-based, self-reported (SR) data and about the potential for identity fraud. This study introduced and tested a novel procedure for assessing the validity of internet-based, SR identity and validated anth...

A case control study: White-collar defendants compared with defendants charged with other nonviolent theft.

PubMed

Poortinga, Ernest; Lemmen, Craig; Jibson, Michael D

2006-01-01

We examined the clinical, criminal, and sociodemographic characteristics of all white-collar crime defendants referred to the evaluation unit of a state center for forensic psychiatry. With 29,310 evaluations in a 12-year period, we found 70 defendants charged with embezzlement, 3 with health care fraud, and no other white-collar defendants (based on the eight crimes widely accepted as white-collar offenses). In a case-control study design, the 70 embezzlement cases were compared with 73 defendants charged with other forms of nonviolent theft. White-collar defendants were found to have a higher likelihood of white race (adjusted odds ratio (adj. OR) = 4.51), more years of education (adj. OR = 3471), and a lower likelihood of substance abuse (adj. OR = .28) than control defendants. Logistic regression modeling showed that the variance in the relationship between unipolar depression and white-collar crime was more economically accounted for by education, race, and substance abuse.

Medicare and state health care programs: fraud and abuse, civil money penalties and intermediate sanctions for certain violations by health maintenance organizations and competitive medical plans--HHS. Final rule.

PubMed

1994-07-15

This final rule implements sections 9312(c)(2), 9312(f), and 9434(b) of Public Law 99-509, section 7 of Public Law 100-93, section 4014 of Public Law 100-203, sections 224 and 411(k)(12) of Public Law 100-360, and section 6411(d)(3) of Public Law 101-239. These provisions broaden the Secretary's authority to impose intermediate sanctions and civil money penalties on health maintenance organizations (HMOs), competitive medical plans, and other prepaid health plans contracting under Medicare or Medicaid that (1) substantially fail to provide an enrolled individual with required medically necessary items and services; (2) engage in certain marketing, enrollment, reporting, or claims payment abuses; or (3) in the case of Medicare risk-contracting plans, employ or contract with, either directly or indirectly, an individual or entity excluded from participation in Medicare. The provisions also condition Federal financial participation in certain State payments on the State's exclusion of certain prohibited entities from participation in HMO contracts and waiver programs. This final rule is intended to significantly enhance the protections for Medicare beneficiaries and Medicaid recipients enrolled in a HMO, competitive medical plan, or other contracting organization under titles XVIII and XIX of the Social Security Act.

The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations

PubMed Central

Sanders, Tekla B; Bowens, Felicia M; Pierce, William; Stasher-Booker, Bridgette; Thompson, Erica Q; Jones, Warren A

2012-01-01

This article will examine the benefits and challenges of the US healthcare system's upcoming conversion to use of the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) and will review the cost implications of the transition. Benefits including improved quality of care, potential cost savings from increased accuracy of payments and reduction of unpaid claims, and improved tracking of healthcare data related to public health and bioterrorism events are discussed. Challenges are noted in the areas of planning and implementation, the financial cost of the transition, a shortage of qualified coders, the need for further training and education of the healthcare workforce, and the loss of productivity during the transition. Although the transition will require substantial implementation and conversion costs, potential benefits can be achieved in the areas of data integrity, fraud detection, enhanced cost analysis capabilities, and improved monitoring of patients’ health outcomes that will yield greater cost savings over time. The discussion concludes with recommendations to healthcare organizations of ways in which technological advances and workforce training and development opportunities can ease the transition to the new coding system. PMID:22548024

Doctors aren't immune to theft and fraud

PubMed Central

Marcus, Gary

1995-01-01

A chartered accountant says the problem of fraud within medical practices is far from rare, even though prevention is relatively simple. Gary Marcus provides advice to physicians about ways to spot fraud within their practices and things they can do to prevent it. No matter how small your practice or how long you have had the same employees, says Marcus, given the right circumstances anyone might steal from you. Imagesp940-a PMID:7697586

Joint Contingency Contracting: Improving Through Ethics

DTIC Science & Technology

2009-05-04

sound ethical decisions. In order to avoid fraud, bribery , contractor kickbacks, or even any perception of activity that may not be in line with...avoid fraud, bribery , contractor kickbacks, or even any perception of activity that may not be in line with the proper use of U.S. Government funds, it...Efforts and Investments, released 11 Mar 2007. 1 INTRODUCTION Hardly a week goes by without a breaking news story dealing with fraud, bribery

Crisis management can leave residual effects.

PubMed

Margolis, G L; DeMuro, P R

1991-10-01

A healthcare organization that once suffered from poor financial performance may fail to correct recovery methods that can cause lingering legal and accounting problems. A crisis management style is prone to creating problems with an organization's debt structure, Medicare and Medicaid payment, tax issues, labor relations, licensing and accreditation, compliance with fraud and abuse rules, and accounting for charity care. After stabilizing a worrisome financial situation, a healthcare organization should conduct an internal audit to ensure that its legal and accounting practices remain above board.

[Hortus simplicum: the first attempt of practical teaching].

PubMed

Serarcangeli, Carla

2004-01-01

Teaching the correct use of the plants for therapeutic purposes was basic for medicine studies. Since the XVI century Universities created professorship roles for the lectura simplicium. An hortus simplicium was very important for the teaching methodology as a training place for the student. It could give the chance to recognize "in vivo" the simplices and their medicinal properties. A specific attention of the physician in taking care of his own patients also protected them from the mistakes and fraudes of the spetiali.

32 CFR 516.4 - Responsibilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... other attorneys designated by the Chief will represent DA in all procurement fraud and corruption... procurement fraud and corruption. (o) Chief, Environmental Law Division, USALSA. The Chief, Environmental Law...

Identity Theft and Consumer Health Education: A Case Study Teaching the Skill of Decision Making

ERIC Educational Resources Information Center

Jefson, Cristy A.

2007-01-01

Identity theft is the fastest growing white-collar crime in America, increasing 40% annually. Identity theft occurs when personal-identifying information, such as a social security number, date of birth, or address, is used to commit fraud. From January 1, 2005, to December 31, 2005, 255,565 people in the United States were victims of identity…

Securing insurance protection against fraud and abuse liability.

PubMed

Callison, S

1999-07-01

Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes.

Digital technology for health sector governance in low and middle income countries: a scoping review.

PubMed

Holeman, Isaac; Cookson, Tara Patricia; Pagliari, Claudia

2016-12-01

Poor governance impedes the provision of equitable and cost-effective health care in many low- and middle-income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, "good governance" interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care. Multi-stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized. We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified little formal evaluative research. Innovative digital approaches are increasingly being used to facilitate good governance in the health sectors of LMICs but evidence of their effectiveness is still limited. More empirical studies are needed to measure concrete impacts, document mechanisms of action, and elucidate the political and sociotechnical dynamics that make designing and implementing ICTs for good governance so complex. Many digital good governance interventions are driven by an assumption that transparency alone will effect change; however responsive feedback mechanisms are also likely to be necessary.

32 CFR 516.63 - Coordination with DOJ.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.63 Coordination with DOJ... significant fraud and corruption cases to accomplish the following: (1) Monitor criminal prosecutions. (2...

Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance.

PubMed

André, Jean-Marie; Azzedine, Fabienne

2016-01-01

In France in 2012, of the total population of 65.2 million, 8.7 % were migrants. After being the third principal host country, France is now the 6th highest host country in the OECD. Since the 1980's numerous Acts have been passed by parliament on immigration issues. In 2000 the Universal Health Cover (Couverture Maladie Universelle) was created as health coverage for all residents of France. At the same time the State Medical Assistance (Aide Médicale de l'Etat) was created as health protection for undocumented migrants. Since the creation of this scheme, it has been the object of many political debates which call it into question, on account of its cost, perceived fraud, and the legitimacy of a social protection for undocumented migrants. Recently, access to State Medical Assistance has been made difficult by introducing conditions of residence and financial contributions. After a reports' analysis on institutional, associative, research studies and European recommendations, we note that all reports converge on the necessity of health protection for undocumented migrants. The major reasons are humanitarian, respect of European and International conventions, for public health, and financial. Moreover, fraud allegations have proved to be unfounded. Finally, State Medical Assistance is underused: in 2014 data from Médecins du Monde shows that only 10.2 % of undocumented migrant patients in their health facilities have access to this scheme. We conclude that the political debate concerning the State Medical Assistance should be about its under-utilisation, its improvement, its merger with the Universal Health Cover, and not its elimination. Moreover, the current debates regarding this scheme stigmatize this population, which is already precarious, making it more difficult for migrants to access healthcare, and generally, weaken national social cohesion.

Home Health Chains and Practice Patterns: Evidence of 2008 Medicare Reimbursement Revision.

PubMed

Huang, Sean Shenghsiu; Kim, Hyunjee

2017-10-01

Home health agencies (HHAs) are known to exploit the Medicare reimbursement schedule by targeting a specific number of therapy visits. These targeting behaviors cause unnecessary medical spending. The Centers for Medicare & Medicaid Services estimates that during fiscal year 2015, Medicare made more than $10 billion in improper payments to HHAs. Better understanding of heterogeneous gaming behaviors among HHAs can inform policy makers to more effectively oversee the home health care industry. This article aims to study how home health chains adjust and adopt new targeting behaviors as compared to independent agencies under the new reimbursement schedule. The analytic data are constructed from: (1) 5% randomly sampled Medicare home health claim data, and (2) HHA chain information extracted from the Medicare Cost Report. The study period spans from 2007 to 2010, and the sample includes 7800 unique HHAs and 380,118 treatment episodes. A multivariate regression model is used to determine whether chain and independent agencies change their practice patterns and adopt different targeting strategies after the revision of the reimbursement schedule in 2008. This study finds that independent agencies are more likely to target 6 and 14 visits, while chain agencies are more likely to target 20 visits. Such a change of practice patterns is more significant among for-profit HHAs. The authors expect these findings to inform policy makers that organizational structures, especially the combination of for-profit status and chain affiliation, should be taken into the consideration when detecting medical fraud and designing the reimbursement schedule.

Department of Justice

MedlinePlus

... of Seized Property Submit a Complaint Report Waste, Fraud, Abuse or Misconduct Find a Form Register, Apply ... Preparer Sentenced to Prison For Tax and Bankruptcy Fraud Thursday, November 16, 2017 Assistant Attorney General Makan ...

27 CFR 19.561 - Losses in general.

Code of Federal Regulations, 2010 CFR

2010-04-01

... appropriate TTB officer finds that the theft occurred without connivance, collusion, fraud or negligence on..., collusion, fraud, or negligence on the part of the proprietor, owner, consignor, consignee, bailee, or...

Strong Internal Controls at Service Delivery Level Will Help Prevent CETA-Type Fraud and Abuse in Job Training Partnership Act Programs. Report to Senator Sam Nunn, Ranking Minority Member, Permanent Subcommittee on Investigations, Senate Committee on Governmental Affairs.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

The Government Accounting Office (GAO) conducted an examination of patterns and causes of fraud in Comprehensive Employment and Training Act (CETA) programs to determine how implementation of Job Training Partnership Act (JTPA) programs might be made less vulnerable to exploitation. GAO's investigation found that fraud and abuse in CETA programs…

Food fraud and the perceived integrity of European food imports into China.

PubMed

Kendall, H; Naughton, P; Kuznesof, S; Raley, M; Dean, M; Clark, B; Stolz, H; Home, R; Chan, M Y; Zhong, Q; Brereton, P; Frewer, L J

2018-01-01

Persistent incidents of food fraud in China have resulted in low levels of consumer trust in the authenticity and safety of food that is domestically produced. We examined the relationship between the concerns of Chinese consumers regarding food fraud, and the role that demonstrating authenticity may play in relieving those concerns. A two-stage mixed method design research design was adopted. First, qualitative research (focus groups n = 7) was conducted in three Chinese cities, Beijing, Guangzhou and Chengdu to explore concerns held by Chinese consumers in relation to food fraud. A subsequent quantitative survey (n = 850) tested hypotheses derived from the qualitative research and theoretical literature regarding the relationship between attitudinal measures (including risk perceptions, social trust, and perceptions of benefit associated with demonstrating authenticity), and behavioral intention to purchase "authentic" European products using structural equation modelling. Chinese consumers perceive food fraud to be a hazard that represents a food safety risk. Food hazard concern was identified to be geographically influenced. Consumers in Chengdu (tier 2 city) possessed higher levels of hazard concern compared to consumers in Beijing and Guangzhou (tier 1). Structural trust (i.e. trust in actors and the governance of the food supply chain) was not a significant predictor of attitude and intention to purchase authenticated food products. Consumers were shown to have developed 'risk-relieving' strategies to compensate for the lack of trust in Chinese food and the dissonance experienced as a consequence of food fraud. Indexical and iconic authenticity cues provided by food manufacturers and regulators were important elements of product evaluations, although geographical differences in their perceived importance were observed. Targeted communication of authenticity assurance measures, including; regulations; enforcement; product testing; and actions taken by industry may improve Chinese consumer trust in the domestic food supply chain and reduce consumer concerns regarding the food safety risks associated with food fraud. To support product differentiation and retain prestige, European food manufactures operating within the Chinese market should recognise regional disparities in consumer risk perceptions regarding food fraud and the importance of personal risk mitigation strategies adopted by Chinese consumers to support the identification of authentic products.

Food fraud and the perceived integrity of European food imports into China

PubMed Central

Raley, M.; Dean, M.; Clark, B.; Stolz, H.; Home, R.; Chan, M. Y.; Zhong, Q.; Brereton, P.; Frewer, L. J.

2018-01-01

Background/Aims Persistent incidents of food fraud in China have resulted in low levels of consumer trust in the authenticity and safety of food that is domestically produced. We examined the relationship between the concerns of Chinese consumers regarding food fraud, and the role that demonstrating authenticity may play in relieving those concerns. Methods A two-stage mixed method design research design was adopted. First, qualitative research (focus groups n = 7) was conducted in three Chinese cities, Beijing, Guangzhou and Chengdu to explore concerns held by Chinese consumers in relation to food fraud. A subsequent quantitative survey (n = 850) tested hypotheses derived from the qualitative research and theoretical literature regarding the relationship between attitudinal measures (including risk perceptions, social trust, and perceptions of benefit associated with demonstrating authenticity), and behavioral intention to purchase “authentic” European products using structural equation modelling. Results Chinese consumers perceive food fraud to be a hazard that represents a food safety risk. Food hazard concern was identified to be geographically influenced. Consumers in Chengdu (tier 2 city) possessed higher levels of hazard concern compared to consumers in Beijing and Guangzhou (tier 1). Structural trust (i.e. trust in actors and the governance of the food supply chain) was not a significant predictor of attitude and intention to purchase authenticated food products. Consumers were shown to have developed ‘risk-relieving’ strategies to compensate for the lack of trust in Chinese food and the dissonance experienced as a consequence of food fraud. Indexical and iconic authenticity cues provided by food manufacturers and regulators were important elements of product evaluations, although geographical differences in their perceived importance were observed. Conclusions Targeted communication of authenticity assurance measures, including; regulations; enforcement; product testing; and actions taken by industry may improve Chinese consumer trust in the domestic food supply chain and reduce consumer concerns regarding the food safety risks associated with food fraud. To support product differentiation and retain prestige, European food manufactures operating within the Chinese market should recognise regional disparities in consumer risk perceptions regarding food fraud and the importance of personal risk mitigation strategies adopted by Chinese consumers to support the identification of authentic products. PMID:29791434

What pharmacy practitioners need to know about ethics in scientific publishing

PubMed Central

Zunic, Lejla; Masic, Izet

2014-01-01

Pharmacy practice is an ever-changing science and profession. We are witnessing many advancement of pharmacy technology, drug-related information and applied clinical pharmacy literature, which influence our every day's life. Thus, new knowledge generated by research and clinical experience widen the knowledge; change the understanding of drugs and their application in therapeutics and every days life. Thus, policy makers, pharmacists, clinicians and researchers must evaluate and use the information existing in the literature to implement in their healthcare delivery. This paper is prepared for pharmacy researchers and pharmacy students and analyzes the major principles of ethical conduct in general science and also closely related topics on ghost authorship, conflict of interest, assigning co-authorship, redundant/repetitive and duplicate publication. Furthermore, the paper provides an insight into fabrication and falsification of data, as the most common form of scientific fraud. Scientific misconduct goes against everything that normal scientific method wants to reach for and pharmacy practitioners as one the first line available health care professionals all round the world should be enough aware of its importance and details when they want to evaluate the medical and pharmaceutical literature and deliver unbiased and ethically published knowledge of drugs both for the research or during consultations for patients care. PMID:25535618

Practice Benchmarking in the Age of Targeted Auditing

PubMed Central

Langdale, Ryan P.; Holland, Ben F.

2012-01-01

The frequency and sophistication of health care reimbursement auditing has progressed rapidly in recent years, leaving many oncologists wondering whether their private practices would survive a full-scale Office of the Inspector General (OIG) investigation. The Medicare Part B claims database provides a rich source of information for physicians seeking to understand how their billing practices measure up to their peers, both locally and nationally. This database was dissected by a team of cancer specialists to uncover important benchmarks related to targeted auditing. All critical Medicare charges, payments, denials, and service ratios in this article were derived from the full 2010 Medicare Part B claims database. Relevant claims were limited by using Medicare provider specialty codes 83 (hematology/oncology) and 90 (medical oncology), with an emphasis on claims filed from the physician office place of service (11). All charges, denials, and payments were summarized at the Current Procedural Terminology code level to drive practice benchmarking standards. A careful analysis of this data set, combined with the published audit priorities of the OIG, produced germane benchmarks from which medical oncologists can monitor, measure and improve on common areas of billing fraud, waste or abuse in their practices. Part II of this series and analysis will focus on information pertinent to radiation oncologists. PMID:23598847

Medical homicide and extreme negligence.

PubMed

Duncanson, Emily; Richards, Virginia; Luce, Kasey M; Gill, James R

2009-03-01

Deaths that occur during medical care for the treatment of a disease are rarely certified as homicides. Some "medical" deaths, however, have been criminally prosecuted for manslaughter, reckless endangerment, or reckless homicide. We describe 5 deaths due to medical complications that underwent criminal prosecution. Three of the deaths were certified as homicides. Deaths certified as homicides due to the actions (or inactions) of a caregiver occur in 3 circumstances. The first is when the medical caregiver intentionally causes the death of the patient. The second is a death due to treatment by an unlicensed fraud or quack. The final circumstance is due to extreme medical negligence that involves a gross and wanton disregard for the well-being of the patient and is the most controversial in the medical community. The law defines reckless endangerment as the conscious disregard of a known substantial likelihood of injury to the patient. Criminal neglect typically is defined as the failure to provide timely, safe, adequate, and appropriate services, treatment, and/or care to a patient. In instances of extreme medical negligence, a homicide manner of death is appropriate because the fatality is due to the criminal acts (or inactions) of another. It also furthers one of the major goals of the medicolegal death investigation system, which is to safeguard the public health.

Practice benchmarking in the age of targeted auditing.

PubMed

Langdale, Ryan P; Holland, Ben F

2012-11-01

The frequency and sophistication of health care reimbursement auditing has progressed rapidly in recent years, leaving many oncologists wondering whether their private practices would survive a full-scale Office of the Inspector General (OIG) investigation. The Medicare Part B claims database provides a rich source of information for physicians seeking to understand how their billing practices measure up to their peers, both locally and nationally. This database was dissected by a team of cancer specialists to uncover important benchmarks related to targeted auditing. All critical Medicare charges, payments, denials, and service ratios in this article were derived from the full 2010 Medicare Part B claims database. Relevant claims were limited by using Medicare provider specialty codes 83 (hematology/oncology) and 90 (medical oncology), with an emphasis on claims filed from the physician office place of service (11). All charges, denials, and payments were summarized at the Current Procedural Terminology code level to drive practice benchmarking standards. A careful analysis of this data set, combined with the published audit priorities of the OIG, produced germane benchmarks from which medical oncologists can monitor, measure and improve on common areas of billing fraud, waste or abuse in their practices. Part II of this series and analysis will focus on information pertinent to radiation oncologists.

Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations. Extension of temporary moratoria.

PubMed

2017-07-28

This document announces the extension of statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non-emergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children's Health Insurance Program in those states.

Special report on taxation. IRS issues stricter guidelines for audits of tax-exempt hospitals.

PubMed

Solomon, J E

1992-07-01

The new audit guidelines serve as yet another reminder to tax-exempt hospitals that great care must be taken in structuring and documenting business arrangements with physicians and executives so as to withstand scrutiny by the IRS with regard to exempt status. Since increased census and utilization, and enhancement of the hospital's financial position, are no longer acceptable justifications for such activities as physician recruitment incentives (being suggestive of payment for referrals), it is important that hospitals make an effort to ensure that board minutes, recruitment policies, internal memoranda, and other documentation set forth the reasons--other than the benefits to the institution's bottom line--for having entered into such transactions. Hospitals must establish and document a community need for each physician recruited. Hospitals that actively recruit should be armed with studies evaluating recruiting needs in each clinical area, based on objective criteria, taking into consideration managed care contracting needs and the provision of services to the poor and needy. Finally, hospitals should re-examine all joint ventures and other business relationships with physicians to determine whether such arrangements resulted from arm's length negotiation, involve fair market value for goods and services, and conform, insofar as possible, with the Medicare fraud and abuse safe harbor regulations. Under GCM 39862 and the new guidelines, "aggressive" arrangements may not only create exposure under fraud and abuse laws, but could jeopardize the provider's tax-exempt status as well.

76 FR 42469 - Conditions of Guarantee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... be liable for payments made by USDA to any holder in the event of ``material fraud, negligence or misrepresentation by the lender or the lender's participation in or condoning of such material fraud, negligence or...

76 FR 42593 - Conditions of Guarantee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... be liable for payments made by USDA to any holder in the event of ``material fraud, negligence or misrepresentation by the lender or the lender's participation in or condoning of such material fraud, negligence or...

Science ethics education part I. Perception and attitude toward scientific fraud among medical researchers.

PubMed

Vuckovic-Dekic, L; Gavrilovic, D; Kezic, I; Bogdanovic, G; Brkic, S

2011-01-01

To assess the knowledge of basic principles of responsible conduct of research and attitude toward the violations of good scientific practice among graduate biomedical students. A total of 361 subjects entered the study. The study group consisted mainly of graduate students of Medicine (85%), and other biomedical sciences (15%). Most participants were on PhD training or on postdoctoral training. A specially designed anonymous voluntary multiple-choice questionnaire was distributed to them. The questionnaire consisted of 43 questions divided in 7 parts, each aimed to assess the participants' previous knowledge and attitudes toward ethical principles of science and the main types of scientific fraud, falsification, fabrication of data, plagiarism, and false authorship. Although they considered themselves as insufficiently educated on science ethics, almost all participants recognized all types of scientific fraud, qualified these issues as highly unethical, and expressed strong negative attitude toward them. Despite that, only about half of the participants thought that superiors-violators of high ethical standards of science deserve severe punishment, and even fewer declared that they would whistle blow. These percentages were much greater in cases when the students had personally been plagiarized. Our participants recognized all types of scientific fraud as violation of ethical standards of science, expressed strong negative attitude against fraud, and believed that they would never commit fraud, thus indicating their own high moral sense. However, the unwillingness to whistle blow and to punish adequately the violators might be characterized as opportunistic behavior.

Two barriers to realizing the benefits of biometrics: a chain perspective on biometrics and identity fraud as biometrics' real challenge

NASA Astrophysics Data System (ADS)

Grijpink, Jan

2004-06-01

Along at least twelve dimensions biometric systems might vary. We need to exploit this variety to manoeuvre biometrics into place to be able to realise its social potential. Subsequently, two perspectives on biometrics are proposed revealing that biometrics will probably be ineffective in combating identity fraud, organised crime and terrorism: (1) the value chain perspective explains the first barrier: our strong preference for large scale biometric systems for general compulsory use. These biometric systems cause successful infringements to spread unnoticed. A biometric system will only function adequately if biometrics is indispensable for solving the dominant chain problem. Multi-chain use of biometrics takes it beyond the boundaries of good manageability. (2) the identity fraud perspective exposes the second barrier: our traditional approach to identity verification. We focus on identity documents, neglecting the person and the situation involved. Moreover, western legal cultures have made identity verification procedures known, transparent, uniform and predictable. Thus, we have developed a blind spot to identity fraud. Biometrics provides good potential to better checking persons, but will probably be used to enhance identity documents. Biometrics will only pay off if it confronts the identity fraudster with less predictable verification processes and more risks of his identity fraud being spotted. Standardised large scale applications of biometrics for general compulsory use without countervailing measures will probably produce the reverse. This contribution tentatively presents a few headlines for an overall biometrics strategy that could better resist identity fraud.

20 CFR 641.450 - Are there responsibility conditions that alone will disqualify an applicant?

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Additionally, significant fraud or criminal activity will typically include coordinated patterns or behaviors... a case-by-case basis regardless of what party identifies the alleged fraud or criminal activity. ...

Computer-aided auditing of prescription drug claims.

PubMed

Iyengar, Vijay S; Hermiz, Keith B; Natarajan, Ramesh

2014-09-01

We describe a methodology for identifying and ranking candidate audit targets from a database of prescription drug claims. The relevant audit targets may include various entities such as prescribers, patients and pharmacies, who exhibit certain statistical behavior indicative of potential fraud and abuse over the prescription claims during a specified period of interest. Our overall approach is consistent with related work in statistical methods for detection of fraud and abuse, but has a relative emphasis on three specific aspects: first, based on the assessment of domain experts, certain focus areas are selected and data elements pertinent to the audit analysis in each focus area are identified; second, specialized statistical models are developed to characterize the normalized baseline behavior in each focus area; and third, statistical hypothesis testing is used to identify entities that diverge significantly from their expected behavior according to the relevant baseline model. The application of this overall methodology to a prescription claims database from a large health plan is considered in detail.

The jurisprudential nature of fraud in biomedical publishing.

PubMed

Candlish, John

2008-06-01

When instances of fraud in biomedical publishing come to light there is widespread indignation, not least because the consequences seem usually only to be internal enquiries and professional displeasure. A number of bodies have been constituted to improve publishing ethics and but these are largely advisory. Potentially though, actions in the tort of deceit and negligence, possibly misfeasance in a public office, and loss of chance could be brought against those responsible. These aspects are examined in the context of English law. In addition the new Fraud Act (2006) appears to be wide enough in scope to cover publishing fraud as a criminal offence. Any organisation such as a drug company financing clinical trials which produce spurious results could face serious losses and might well look to remedies in contract as well as in tort. A theoretical scenario centered on a drug trial is presented in order to explore these issues.

A real time metabolomic profiling approach to detecting fish fraud using rapid evaporative ionisation mass spectrometry.

PubMed

Black, Connor; Chevallier, Olivier P; Haughey, Simon A; Balog, Julia; Stead, Sara; Pringle, Steven D; Riina, Maria V; Martucci, Francesca; Acutis, Pier L; Morris, Mike; Nikolopoulos, Dimitrios S; Takats, Zoltan; Elliott, Christopher T

2017-01-01

Fish fraud detection is mainly carried out using a genomic profiling approach requiring long and complex sample preparations and assay running times. Rapid evaporative ionisation mass spectrometry (REIMS) can circumvent these issues without sacrificing a loss in the quality of results. To demonstrate that REIMS can be used as a fast profiling technique capable of achieving accurate species identification without the need for any sample preparation. Additionally, we wanted to demonstrate that other aspects of fish fraud other than speciation are detectable using REIMS. 478 samples of five different white fish species were subjected to REIMS analysis using an electrosurgical knife. Each sample was cut 8-12 times with each one lasting 3-5 s and chemometric models were generated based on the mass range m/z 600-950 of each sample. The identification of 99 validation samples provided a 98.99% correct classification in which species identification was obtained near-instantaneously (≈ 2 s) unlike any other form of food fraud analysis. Significant time comparisons between REIMS and polymerase chain reaction (PCR) were observed when analysing 6 mislabelled samples demonstrating how REIMS can be used as a complimentary technique to detect fish fraud. Additionally, we have demonstrated that the catch method of fish products is capable of detection using REIMS, a concept never previously reported. REIMS has been proven to be an innovative technique to help aid the detection of fish fraud and has the potential to be utilised by fisheries to conduct their own quality control (QC) checks for fast accurate results.

38 CFR 3.901 - Fraud.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Compensation, and Dependency and Indemnity Compensation Forfeiture § 3.901 Fraud. (a) Definition. An act... death benefit payable. (2) Amount of compensation payable but for the forfeiture. No benefits are... affidavit, declaration, certificate, statement, voucher, or paper, concerning any claim for benefits under...

76 FR 49522 - Self-Regulatory Organizations; NYSE Amex LLC; Notice of Filing of Proposed Rule Change Amending...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... company. \\5\\ 15 U.S.C. 77a. Significant regulatory concerns, including accounting fraud allegations, have... listed company) is not engaged in undetected accounting fraud or subject to other concealed and...

Poster: Report Fraud Waste and Abuse to the EPA OIG Hotline

EPA Pesticide Factsheets

The EPA OIG hotline receives complaints of fraud, waste, and abuse in EPA and U.S. Chemical Safety Board programs and operations including mismanagement or violations of law, rules, or regulations by EPA employees or program participants.

Fraud and Australian Academics.

ERIC Educational Resources Information Center

Martin, Brian

1989-01-01

A series of highly publicized cases of alleged fraud in the Australian academic community are described. Each case reveals an apparent failure of peer review. The right to pursue investigations and make comments that may offend powerful figures within the scholarly community is precarious. (MLW)

77 FR 39781 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing of Proposed Rule Change To...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-05

... would be for an IPO. \\3\\ 15 U.S.C. 77a. Significant regulatory concerns, including accounting fraud... accounting fraud or subject to other concealed and undisclosed legal or regulatory problems. For purposes of...

12 CFR 1731.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND SOUNDNESS MORTGAGE FRAUD REPORTING § 1731.2 Definitions. For purposes of this part— (a) Director... Association or the Federal Home Loan Mortgage Corporation. (c) Mortgage fraud means a material misstatement... mortgage, including a mortgage associated with a mortgage-backed security or similar financial instrument...

An Analysis of Fraud on the Internet.

ERIC Educational Resources Information Center

Baker, C. Richard

1999-01-01

Examines the issue of fraud on the Internet and discusses three areas with significant potential for misleading and fraudulent practices: securities sales and trading; electronic commerce, including privacy and information protection; and the rapid growth of Internet companies, including advertising issues. (Author/LRW)

28 CFR 68.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... IMMIGRATION-RELATED EMPLOYMENT PRACTICES, AND DOCUMENT FRAUD § 68.2 Definitions. For purposes of this part: Adjudicatory proceeding means an administrative judicial-type proceeding, before the Office of the Chief... law by an Administrative Law Judge or the Chief Administrative Hearing Officer; Document fraud cases...

28 CFR 68.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... IMMIGRATION-RELATED EMPLOYMENT PRACTICES, AND DOCUMENT FRAUD § 68.2 Definitions. For purposes of this part: Adjudicatory proceeding means an administrative judicial-type proceeding, before the Office of the Chief... law by an Administrative Law Judge or the Chief Administrative Hearing Officer; Document fraud cases...

Odometer Fraud: Traffic Safety Tips

DOT National Transportation Integrated Search

1996-01-01

This fact sheet, NHTSA Facts: Summer 1996, focuses on odometer fraud, which is a major problem for consumers. Some late model used cars have odometers that have been turned back. Any vehicle that has been driven a high number of miles but is only a f...

From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

PubMed

Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John

2017-01-01

Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.

Equal Potential: A Collective Fraud.

ERIC Educational Resources Information Center

Gottfredson, Linda S.

2000-01-01

Critiques the College Board's report, "Reaching the Top," asserting that it illustrates collective fraud in the social sciences, which sustains an egalitarian fiction that intelligence is clustered equally across all human populations. Suggests that while the report omits certain popular falsehoods, it also omits crucial truths about…

20 CFR 627.500 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... contained in this subpart shall be deemed to prejudice the separate exercise of other legal rights in...) Complaints and reports of criminal fraud, waste, and abuse. Information and complaints involving criminal fraud, waste, abuse or other criminal activity shall be reported through the Department's Incident...

7 CFR 1.302 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Under the Program Fraud Civil Remedies Act of 1986 § 1.302 Definitions. (a) Agency means a constituent organizational unit of the USDA. (b) Agency Fraud Claims Officer—(AFCO) means an officer or employee of an agency...) Statement means any representation, certification, affirmation, document, record, or accounting or...

17 CFR 48.8 - Conditions of registration.

Code of Federal Regulations, 2013 CFR

2013-04-01

...; prohibit fraud, abuse, and market manipulation and other disruptions of the market; and provide that such... any market manipulation, abuse, fraud, deceit, or conversion or that results in suspension or... continue to satisfy the criteria for a regulated market or licensed exchange pursuant to the regulatory...

17 CFR 48.8 - Conditions of registration.

Code of Federal Regulations, 2014 CFR

2014-04-01

...; prohibit fraud, abuse, and market manipulation and other disruptions of the market; and provide that such... any market manipulation, abuse, fraud, deceit, or conversion or that results in suspension or... continue to satisfy the criteria for a regulated market or licensed exchange pursuant to the regulatory...

17 CFR 48.8 - Conditions of registration.

Code of Federal Regulations, 2012 CFR

2012-04-01

...; prohibit fraud, abuse, and market manipulation and other disruptions of the market; and provide that such... any market manipulation, abuse, fraud, deceit, or conversion or that results in suspension or... continue to satisfy the criteria for a regulated market or licensed exchange pursuant to the regulatory...

Looking at Debit and Credit Card Fraud

ERIC Educational Resources Information Center

Porkess, Roger; Mason, Stephen

2012-01-01

This article, written jointly by a mathematician and a barrister, looks at some of the statistical issues raised by court cases based on fraud involving chip and PIN cards. It provides examples and insights that statistics teachers should find helpful. (Contains 4 tables and 1 figure.)

8 CFR 270.2 - Enforcement procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PENALTIES FOR DOCUMENT FRAUD § 270.2 Enforcement procedures. (a) Procedures for the filing of complaints. Any person or entity... charges for document fraud committed by refugees at the time of entry. The Service shall not issue a...

Lock Up Those Lines: Protecting against Phone Fraud.

ERIC Educational Resources Information Center

Schleyer, Peggy E.; Hibner, Dale V.

1996-01-01

School business officials must be aware of potential liabilities associated with Centrex and Private Branch Exchange (PBX). This article describes these systems, presents guidelines for developing a telecommunications management plan, and discusses options to limit toll fraud exposure. PBX owners should implement manufacturers' recommended…

42 CFR 455.1 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for a State fraud detection and investigation program, and for disclosure of information on ownership... Security Act, Subpart A provides State plan requirements for the identification, investigation, and referral of suspected fraud and abuse cases. In addition, the subpart requires that the State— (1) Report...

76 FR 80901 - Agency Information Collection Activities Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... monitoring legal proceedings involving the responsibilities imposed on contract markets and their officials... avoid fraud and misrepresentations. In addition, the Commission's rules impose obligations on contract markets that are designed to avoid manipulation and fraud. In order to ensure compliance with these rules...

20 CFR 625.14 - Overpayments; disqualification for fraud.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DISASTER UNEMPLOYMENT ASSISTANCE § 625.14 Overpayments; disqualification for fraud. (a) Finding and... unemployment compensation law administered by the State agency, or from any assistance or allowance payable to the individual with respect to unemployment under any other Federal law administered by the State...

20 CFR 625.14 - Overpayments; disqualification for fraud.

Code of Federal Regulations, 2012 CFR

2012-04-01

... DISASTER UNEMPLOYMENT ASSISTANCE § 625.14 Overpayments; disqualification for fraud. (a) Finding and... unemployment compensation law administered by the State agency, or from any assistance or allowance payable to the individual with respect to unemployment under any other Federal law administered by the State...

20 CFR 625.14 - Overpayments; disqualification for fraud.

Code of Federal Regulations, 2014 CFR

2014-04-01

... DISASTER UNEMPLOYMENT ASSISTANCE § 625.14 Overpayments; disqualification for fraud. (a) Finding and... unemployment compensation law administered by the State agency, or from any assistance or allowance payable to the individual with respect to unemployment under any other Federal law administered by the State...

20 CFR 625.14 - Overpayments; disqualification for fraud.

Code of Federal Regulations, 2011 CFR

2011-04-01

... DISASTER UNEMPLOYMENT ASSISTANCE § 625.14 Overpayments; disqualification for fraud. (a) Finding and... unemployment compensation law administered by the State agency, or from any assistance or allowance payable to the individual with respect to unemployment under any other Federal law administered by the State...

20 CFR 625.14 - Overpayments; disqualification for fraud.

Code of Federal Regulations, 2013 CFR

2013-04-01

... DISASTER UNEMPLOYMENT ASSISTANCE § 625.14 Overpayments; disqualification for fraud. (a) Finding and... unemployment compensation law administered by the State agency, or from any assistance or allowance payable to the individual with respect to unemployment under any other Federal law administered by the State...

An appraisal of the performance of the economic and financial crimes commission in Nigeria.

PubMed

Sowunmi, Fatai Abiola; Adesola, Muniru Adekunle; Salako, Mudashiru Abiodun

2010-12-01

This article examines how an anti-graft body, the Economic and Financial Crime Commission (EFCC), has fared in reducing the incidence of corruption in Nigeria, in particular, bank fraud, Internet scam, and bad governance. It first discusses the corruption situation in Nigeria by highlighting public office holders who have been associated with corruption charges. A Likert-type scale is used in designing the questionnaire for data collection. Descriptive and chi-square analyses are used, and results reveal that the performance of the EFCC has been affected by government interference (p < .05). However, although the anti-graft body has not been able to reduce the incidence of bank fraud (p > .05), bad governance and advance fee fraud have recorded appreciable reduction (p < .05). Areas of success as well as challenges that need to be addressed are identified. Specifically, it is recommended that the bill that established EFCC should be amended to reduce government interference and improve its manpower development, especially in the areas of fraud and Internet scam detection.

An inequality for detecting financial fraud, derived from the Markowitz Optimal Portfolio Theory

NASA Astrophysics Data System (ADS)

Bard, Gregory V.

2016-12-01

The Markowitz Optimal Portfolio Theory, published in 1952, is well-known, and was often taught because it blends Lagrange Multipliers, matrices, statistics, and mathematical finance. However, the theory faded from prominence in American investing, as Business departments at US universities shifted from techniques based on mathematics, finance, and statistics, to focus instead on leadership, public speaking, interpersonal skills, advertising, etc… The author proposes a new application of Markowitz's Theory: the detection of a fairly broad category of financial fraud (called "Ponzi schemes" in American newspapers) by looking at a particular inequality derived from the Markowitz Optimal Portfolio Theory, relating volatility and expected rate of return. For example, one recent Ponzi scheme was that of Bernard Madoff, uncovered in December 2008, which comprised fraud totaling 64,800,000,000 US dollars [23]. The objective is to compare investments with the "efficient frontier" as predicted by Markowitz's theory. Violations of the inequality should be impossible in theory; therefore, in practice, violations might indicate fraud.

Head Start: Undercover Testing Finds Fraud and Abuse at Selected Head Start Centers. Testimony before the Committee on Education and Labor, House of Representatives. GAO-10-733T

ERIC Educational Resources Information Center

Kutz, Gregory D.

2010-01-01

The Head Start program, overseen by the Department of Health and Human Services and administered by the Office of Head Start, provides child development services primarily to low-income families and their children. Federal law allows up to 10 percent of enrolled families to have incomes above 130 percent of the poverty line--GAO (Government…

Student Financial Assistance Programs. Hearings Before a Subcommittee of the Committee on Government Operations, House of Representatives, Ninety-Fifth Congress, Second Session. July 27; August 3; and October 5, 1978.

ERIC Educational Resources Information Center

Congress of the U. S., Washington, DC. House Committee on Government Operations.

Three hearings held before the U.S. House of Representatives on student financial assistance programs were concerned with the manner in which the Office of Education's assistance programs were being administered, the extent and nature of fraud, waste and abuse, and the progress of the Department of Health, Education, and Welfare's (HEW) corrective…

Document fraud deterrent strategies: four case studies

NASA Astrophysics Data System (ADS)

Mercer, John W.

1998-04-01

This paper discusses the approaches taken to deter fraud committed against four documents: the machine-readable passport; the machine-readable visa; the Consular Report of Birth Abroad; and the Border Crossing Card. General approaches are discussed first, with an emphasis on the reasons for the document, the conditions of its use and the information systems required for it to function. A cost model of counterfeit deterrence is introduced. Specific approaches to each of the four documents are then discussed, in light of the issuance circumstances and criteria, the intent of the issuing authority, the applicable international standards and the level of protection and fraud resistance appropriate for the document.

Individual researcher liability for clinical research on humans.

PubMed

Miller, Ruth K

2003-01-01

Despite international guidelines and federal regulations, a recent rash of problems in clinical trials have highlighted weaknesses in the oversight process. The federal regulatory system depends on self-policing by researchers and institutions. Because the existing system is overworked, applying common law forms of liability to clinical researchers may encourage improvements in this self-regulation. While research necessarily involves uncertainties, researchers have the greatest direct control over the implementation of the research protocol and the most extensive direct contact with subjects, and must bear corresponding responsibility for acts which fall below the standard of care. This paper argues that the existing FDA patient protections should be adopted as the standards of care for researchers. It examines the possible application of negligence, negligence per se, and fraud and misrepresentation claims against researchers.

41 CFR 105-53.131 - Office of Inspector General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... functions and established an Office of Inspector General in 11 major domestic departments and agencies... United States Attorneys on all matters relating to the detection and prevention of fraud and abuse. The Inspector General reports semiannually to the Congress through the Administrator concerning fraud, abuses...

32 CFR 516.58 - Policies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Policies. 516.58 Section 516.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Remedies in Procurement Fraud and Corruption § 516.58 Policies. (a) Procurement fraud and...

7 CFR 1773.9 - Disclosure of fraud, illegal acts, and other noncompliance.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., the auditor must design the audit to provide reasonable assurance of detecting fraud that is material... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) POLICY ON AUDITS OF RUS BORROWERS RUS Audit... statements, auditors should apply audit procedures specifically directed to ascertaining whether an illegal...

78 FR 79567 - Supplemental Nutrition Assistance Program: Trafficking Controls and Fraud Investigations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-31

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service 7 CFR Parts 271 and 274 RIN 0584-AE26 Supplemental Nutrition Assistance Program: Trafficking Controls and Fraud Investigations AGENCY: Food and Nutrition Service, USDA. ACTION: Final rule, Interim final rule; notice of approval of Information...

Academic Misconduct in Teaching Portfolios

ERIC Educational Resources Information Center

Erikson, Martin G.; Erlandson, Peter; Erikson, Malgorzata

2015-01-01

Within academia, clear and standardised communication is vital. From this point of departure, we discuss the trustworthiness of teaching portfolios when used in assessment. Here, misconduct and fraud are discussed in terms of fabrication, falsification, and plagiarism, following the literature on research fraud. We argue that the portfolio's…

12 CFR 1731.3 - Unsafe and unsound conduct.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEVELOPMENT SAFETY AND SOUNDNESS MORTGAGE FRAUD REPORTING § 1731.3 Unsafe and unsound conduct. An Enterprise may not require the repurchase of or may not decline to purchase a mortgage, mortgage backed security, or similar financial instrument because of possible mortgage fraud without promptly reporting to the...

16 CFR 660.4 - Direct disputes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... direct disputes relating to whether there is or has been identity theft or fraud against the consumer... direct disputes relating to the type of account, principal balance, scheduled payment amount on an... relationship with the consumer); (v) Information related to fraud alerts or active duty alerts; or (vi...

12 CFR 222.43 - Direct disputes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... fraud against the consumer, whether there is individual or joint liability on an account, or whether the... the furnisher, such as direct disputes relating to the type of account, principal balance, scheduled... relationship with the consumer); (v) Information related to fraud alerts or active duty alerts; or (vi...

12 CFR 334.43 - Direct disputes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... furnisher, such as direct disputes relating to whether there is or has been identity theft or fraud against... furnisher, such as direct disputes relating to the type of account, principal balance, scheduled payment... relationship with the consumer); (v) Information related to fraud alerts or active duty alerts; or (vi...

48 CFR 849.106 - Fraud or other criminal conduct.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 849.106 Fraud or other criminal conduct. (a... following: (i) The DSPE. (ii) The Director, Office of Construction and Facilities Management, in the case of contracting officers from the Office of Construction and Facilities Management. (3) Follow procedures as...

7 CFR 4279.72 - Conditions of guarantee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... unenforceable by the lender to the extent any loss is occasioned by the violation of usury laws, negligent... participates or condones. In the event of material fraud, negligence or misrepresentation by the lender or the lender's participation in or condoning of such material fraud, negligence or misrepresentation, the...