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Brought down by upcoding
For years William King ran a successful medical practice, but when his patients left his office, the Philadelphia, Pennsylvania, doctor had a practice of a different sort — a medical billing scheme known as upcoding. Fraud Magazine examines how King perpetrated a years’ long upcoding scheme that defrauded an insurance company of hundreds of thousands of dollars and details how fraud examiners can detect similar schemes.
Written By: Colin May, CFE
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- Health Care Fraud
- Insurance Fraud
Gabriella Marshall, CFE
Gabriella Marshall, CFE, major case consultant at Nationwide Insurance, discusses the benefits of earning the Certified Fraud Examiner credential, her professional background, her greatest achievement and more.
Written By: Anna Brahce
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- Career and Professional Development
- Fraud Prevention and Deterrence
- Fraud Risk Management
The irrevocable trust
In 2023, Christopher Linscott, CFE, CPA, CIRA, arranged a donation of $250,000 to the ACFE Foundation — the single largest donation to the foundation ever. Here’s the story of how a Ponzi scheme that bilked thousands of military veterans and retirees became the impetus for that donation.
Written By: Jennifer Liebman, CFE, Mandy Moody, CFE, Jala Attia, CFE
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- Fraud Investigation and Examination
- Fraud Schemes
- Insurance Fraud
Phishers use AI to bypass email security, fake life insurance policy scams and more
Phishing scams never disappeared; they’re just more sophisticated. Also reject letters promising millions from insurance policies. And beware of invoices for COVID-19 tests you never ordered.
Written By: Robert E. Holtfreter, Ph.D., CFE
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- Cyberfraud
- Fraud Schemes
- Identity Theft
Unfairly thrown in a Thai jail for 547 days
The over $4.5 billion theft from Malaysian sovereign wealth fund 1MDB is one of the world’s biggest-ever financial scams and a sad story as it deprived ordinary people in that country of vital resources. Xavier Justo talks about his nightmare experience exposing the fraudsters responsible for this massive theft and the lessons he’s learned along the way.
Written By: Paul Kilby, CFE
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- Bribery and Corruption
- Financial Institution Fraud
- Whistleblowing and Hotlines
Breaking records
Fraud examiners shattered Global Fraud Conference attendance records in Seattle, Washington, cementing ACFE’s hybrid virtual and in-person annual conference as a can’t-miss event. And keynote speakers shared their stories of investigating fraud and corruption and revealing the truth.
Written By: Jennifer Liebman, CFE
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- Fraud Risk Management
- Fraud Schemes
- Whistleblowing and Hotlines
The challenges of change
Members of the ACFE Board of Regents always bring a wealth of experience from their respective sectors. Here they impart their thoughts on an array of topics and the importance of continual learning in the ever-evolving anti-field field.
Written By: Paul Kilby, CFE
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- Anti-Fraud Laws Regulations and Compliance
- Computers and Technology
- Fraud Risk Management
Detecting document fraud
Cases of document fraud, including check fraud, have exploded in recent years. The authors explain what’s behind the proliferation of this age-old scam and the modern technology CFEs can employ to stop it in its tracks.
Written By: Dustin J. Eaton, CFE, Theodore Colon, J.D.
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- Financial Transactions and Fraud Schemes
- Fraud Prevention and Deterrence
- Identity Theft
Gold standard for inspectors general
ACFE President and CEO Bruce Dorris, J.D., CFE, CPA, praises Cressey Award winner Michael Horowitz's achievements in detecting and preventing fraud in his role as inspector general and chair of the Pandemic Response Accountability Committee (PRAC).
Written By: Bruce Dorris, J.D., CFE, CPA
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- Anti-Fraud Laws Regulations and Compliance
- Fraud Investigation and Examination
- Government Fraud
Use advanced tools to fight Medicare fraud
Fraud, waste and abuse emerge in most areas. But, theoretically, the health care system is where most people should least expect them. Of course, fraud has long been a problem in this sector. And most recently Medicare Advantage — the private-sector arm of the U.S. national health system for elderly Americans — and the insurers that manage it have come under intense scrutiny for allegedly submitting false diagnosis codes to inflate payments from the government.
Written By: Bruce Dorris, J.D., CFE, CPA
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- Health Care Fraud
- Insurance Fraud
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