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U.S. seeks to ban Huione Group for money laundering and more
U.S. seeks to ban Huione Group for money laundering. Credit Suisse confesses to tax fraud. UHG investigated for alleged Medicare fraud. Texas doctor who falsely diagnosed patients gets prison sentence.
Written By: Crystal Zuzek
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- Financial Institution Fraud
- Fraud Schemes
- Health Care Fraud
Deception by inundation: How fraudsters play the system in personal injury cases
Tricking insurance and other companies into paying for fake injuries is a perennial, and often complicated, scam. Here the authors examine the three principal players typically involved in these schemes and how evidence of an injury isn’t always what it seems, especially when fraudsters deliberately throw everything but the “kitchen sink” at payers.
Written By: Dennis DiGiorgi, DC, CFE, CHCQM, Jason Tenenbaum, Esq.
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- Fraud Schemes
- Health Care Fraud
- Insurance Fraud
5 most scandalous fraud cases of 2023
We’d just filed our Most Scandalous Frauds story of 2022 when news of the implosion of multibillion-dollar crypto exchange FTX broke. It might’ve been a little too late for us to add what would become the biggest fraud scandal since Theranos to the 2022 list, but the FTX story didn’t disappear, and we had FTX founder Sam Bankman-Fried’s trial and eventual guilty verdict to keep us riveted. Of course, FTX wasn’t the only high-profile case that shocked us; there were many others that had a big impact on the anti-fraud profession. Here are the five fraud cases we found most scandalous in 2023.
Written By: Jennifer Liebman, CFE
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- Bribery and Corruption
- Fraud Schemes
- Health Care Fraud
Evading suspicion through political networking
Sam Bankman-Fried, Elizabeth Holmes and Bernard Madoff. What do they have in common? They apparently used their outsized social influence in their professional networks to illegally expand their bank accounts and prolong their crimes. Fraud fighters can’t also be duped by their wily ways.
Written By: Frank S Perri, J.D., CFE, CPA
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- Bribery and Corruption
- Financial Transactions and Fraud Schemes
- Health Care Fraud
Treating fraud in independent pharmacies
In 2020, the U.S. Department of Justice (DOJ), in its largest health care fraud enforcement action to date, indicted 345 various health care professionals for submitting $6 billion worth of fraudulent claims to federal programs and private insurers. Among those ensnared in the takedown were pharmacies, which were accused of scheming with telemedicine entities and other licensed health care providers to purchase unnecessary medical equipment and prescription pain medications in exchange for illegal kickbacks and bribes, as well as the illegal distribution of opioid drugs. (See “National Health Care Fraud and Opioid Takedown Results in Charges Against 345 Defendants Responsible for More than $6 Billion in Alleged Fraud Losses,” U.S. Department of Justice, press release, Sept. 30, 2020.)
Written By: Meghan Sebaugh, CFE
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- Consumer Fraud and Scams
- Fraud Schemes
- Health Care Fraud
The Medicare disadvantage
Medicare Advantage, the private-sector arm for elderly care, is fast becoming the new battle front in the fight against health care fraud in the U.S. Here's why, and what fraud examiners think should be done.
Written By: Paul Kilby, CFE
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- Fraud Schemes
- Health Care Fraud
- Insurance Fraud
5 most scandalous fraud cases of 2022
It’s hard to believe, but it’s been almost three years since the start of the COVID-19 pandemic, and fraud fighters are still grappling with the fallout of frauds tied to government-relief funds. Yet, despite the massive scale of pandemic frauds and the staggering loss of money, governments made some progress after enacting task forces to investigate COVID-related frauds and recover stolen funds. And while some of the most scandalous frauds of 2022 were connected to the pandemic, it wasn’t all COVID all the time. Indeed, there were plenty of other frauds we believe will live on in infamy and serve as essential case studies for fraud examiners in the years to come. (See “Justice Department Announces COVID-19 Fraud Strike Force Teams,” U.S. DOJ press release, Sept. 14, 2022 and “Secret Service recovers $286 million in stolen COVID relief funds,” by Julia Ainsley and Sarah Fitzpatrick, NBC News, Aug. 26, 2022.)
Written By: Jennifer Liebman, CFE
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- Fraud Schemes
- Health Care Fraud
- Nonprofit 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
Catching health care fraud with statistical graphics
Inflating codes that determine how much Medicare and Medicaid pay to health care providers is common practice among fraudsters. Now they’re doing it in increasingly sophisticated ways. Here we examine how statistical graphics can help spot upcoding in what can be an arcane and complicated billing process.
Written By: Terry Allen, Ph.D., William McBee, CFE, LPI
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- Data Analytics
- Health Care Fraud
Fraudsters, fakes and flaws
Alex Gibney’s documentaries have covered some of the biggest frauds of our times. The award-winning director talks to us about what he’s learned about the psychology of corporate fraud and more. It might not be what you expect.
Written By: Paul Kilby, CFE
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- Fraud Prevention and Deterrence
- Government Fraud
- Health Care Fraud
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