Frauds in Insurance Sector Essay

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  • Health Care Fraud Essay

    Health Care Fraud A health services management issue that caught my interest is “Health Care Fraud”. Health care fraud is an unethical intentional misrepresentation, deception, or intentional act of deceit for the purpose of receiving huge profits. Furthermore, it is a total disregard that goes against and is inconsistent with good business and /or medical practices. Healthcare fraud has become a national problem that affects all of us directly or indirectly. It is mainly perpetrated by fraudsters, scammers, organized criminal gangs and even dishonest doctors, nurses and other licensed medical professionals who allegedly rip-off billions of dollars each year from the Federal and State governments, from American taxpayers and some of our most vulnerable citizens. Unfortunately, health care fraud is the driving factor that is responsible for the high cost of health care that affects all Americans and individuals living in the United States. It occurs in different situations, from unnecessary and duplicate tests, financial fraud, such as embezzling and money laundering, to hacking into patient’s personal medical records and submitting false claims. It also includes mail fraud, misbranding of drugs, illegal marketing and distribution and selling, use of unapproved and counterfeit drugs, and forging signature and documents. Fraudsters commit these various schemes to generate huge profits, causing the cost of health care to skyrocket. In health care, identity theft is the most…

    Words: 1277 - Pages: 6
  • Economic Crime Case Study

    the following broad categories: • Corruption—abusing power related to a particular job or position to gain unlawfully wealth or influence. • Fraud—financial gain obtained through loopholes in regulations, manipulation, or exploitation of public or personal trust (smuggling, illegal operations with hard currency, falsified bankruptcies, forgery, falsified credits, illegal capital flight, and so on). • Theft and extortion (racket)—direct (physical) intervention of criminals; expropriation…

    Words: 2156 - Pages: 9
  • Affects Of Meluare Fraud: Medicare Causes And Impacts

    Medicare fraud is becoming a huge problem in today’s society. Medicare is a health insurance program for personnel paid by taxes the American population contributes to for personnel 65 years or older. When a health care provider, health suppliers, and private health companies deliberately bill Medicare for supplies or services that were not given is considered Medicare Fraud. To include, when a person uses another person’s Medicare card to receive health care for which the person does not…

    Words: 636 - Pages: 3
  • Auditing Practices In Fraud And Error

    socio-economic groups in different ways. For some groups, access may not be compromised by a co-payment, while for others the charge may represent a significant deterrent. The impact depends on the size of the co-payment and crucially depends on the patient’s ability to pay (and therefore directly links with equity considerations). The insurance market (and social insurance-based schemes such as the UK) essentially removes most of the financial barriers to access so that patients do not face the…

    Words: 2394 - Pages: 10
  • Anti Kickback Penalty Case Study

    Healthcare Programs. Discussion Fraud is defined as a deliberate dishonesty or distortion committed by an individual, that effects in some unlawful gain to him/herself or to someone else. According to research, the health care industry is more exposed to scam than any other industry. The health care fraud comes into existence because of the increasing health care cost. Health care deception is seen as an abuse on health care resources. Due to health care fraud, U.S is facing a huge amount of…

    Words: 1556 - Pages:
  • Forensic Accounting Case Study

    2009a; Carnes & Gierlasinski, 2001). In the aftermath of several accounting scandals such as Enron and WorldCom in the USA, HIH Insurance in Australia, Royal Ahold in the Netherlands, Parmalat in Italy, and Equitable Life Assurance Society in the UK (Kleinman & Anandarajan, 2011), as well as the collapse of one of the “Big Five” auditing firms (Arthur Anderson), and the two episodes of financial crises that followed afterwards, awareness about white-collar frauds committed by…

    Words: 4918 - Pages: 20
  • Singapore Banking Case Study

    businesses and individuals, providing investment and insurance services and so on. Banking system is usually regulated by country’s laws and central banks of individual countries. Finance is usually defined as the science of money management. Many studies show that the banking and finance sector of a nation and the performance of overall country economy are directly proportional. Therefore, it is clear that countries with good financial system are more likely to develop its economic growth more…

    Words: 1257 - Pages: 6
  • Advantages And Disadvantages Of Retail Banking

    refers to the dealing of commercial banks with individual customers, both on liabilities and assets sides of the balance sheet. Fixed, current / savings accounts on the liabilities side; and mortgages, loans (e.g., personal, housing, auto, and educational) on the assets side, are the more important of the products offered by banks. Related ancillary services include credit cards, or depository services. Today’s retail banking sector is characterized by three basic characteristics: * Multiple…

    Words: 7285 - Pages: 30
  • Intrinsic Fraud In Contract Law

    Importance of forensic accounting and fraud awareness in Malaysia As a result of recent, highly publicized financial scandals; reported increases in occupational fraud; and heightened concerns over money laundering to support terrorism and racketeering, legislative mandates and public expectations have heightened the necessity to hrther define the auditor's and accountant's responsibility for detecting fraud within organizations. Successful fraud or forensic accounting analyses and findings…

    Words: 4169 - Pages: 17
  • The Definition And Importance Of Health Insurance

    developed in India. This private sector bridges most of the gaps between what government offers and what people need. However, with proliferation of various health care technologies and general price rise, the cost of care has also become very expensive and unaffordable to large segment of population. The government and people have started exploring various health financing options to manage problems arising out of growing set of complexities of private sector growth, increasing cost of care and…

    Words: 4324 - Pages: 18
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