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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
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
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
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
No-fault car insurance scam, tax return fraud and more
Thirteen people indicted for a $100 million no-fault car insurance scam, sisters perpetrate a tax return fraud scam and Pakistan contemplates banning cryptocurrency.
Written By: Jennifer Liebman, CFE
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- Cryptocurrency and Digital Assets
- Insurance Fraud
- Tax Fraud
Telemedicine fraud ripe during COVID-19 pandemic
Telemedicine isn’t a new concept. It’s become an integral element of health care delivery. However, it’s prone to fraud opportunities because of the absence of direct patient contact. U.S. federal loosening of regulations during the pandemic has opened the door for more telemedicine visits and potential for fraud.
Written By: Robert A. Richman, CFE
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- Bribery and Corruption
- Health Care Fraud
- Insurance Fraud
Soft fraud's hard-dollar impact in workers' compensation
On Feb. 10, 2015, Nova Healthcare Management pleaded guilty to felonious workers’ compensation fraud and agreed to repay Texas Mutual Insurance Company more than $6 million. The investigation revealed that Nova Healthcare Management (also known as Nova Medical Centers or Nova) overbilled Texas Mutual for physical therapy by billing services as more expensive one-on-one therapy when it actually provided group therapy.
Written By:
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- Health Care Fraud
- Insurance Fraud
Letters from prison tell the story of a $1.65 million insurance fraud
Fictitious insurance claims filed by Joshua Miller, owner of a Syracuse hearing-aid dispenser, cost the New York state insurance fund $1.65 million. Learn how he, and others, edged the system to commit the crime.
Written By: John E. Little, CFE, CPA, Megan E. Sutton
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- Fraud Schemes
- Insurance Fraud
Audio recording physician exams
Here’s a simple way to help prevent health care fraud. Patients, with their doctors’ consent, can audio record doctor visits with their smartphones. Audio recordings can verify bills submitted for health care services. And medical providers can upload and store audio files in patients’ electronic medical records to help ensure the veracity of physicians’ diagnoses and interventions.
Written By: Kathleen A. Nicholls
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- Fraud Prevention and Deterrence
- Health Care Fraud
- Insurance Fraud
An auto insurance fraud primer and more
Auto insurance fraud is a global fraud phenomenon with billions in losses. This primer will cover the basics plus an innovative way to combat it: social network analysis (SNA). SNA tracks claims patterns among individuals, vehicles, and locations involved in accidents, as well as supports entities such as repair shops, law firms and medical clinics. The result? Evidence discovery.
Written By: Subhash Satyal, MISAM, CFE, CPA (Canada), Pavol Zavarsky, Ph.D., CISSP, CISM, CISA, Shaun Aghili, D.B.A., CFE, CIA, CISSP-ISSMP
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- Fraud Investigation and Examination
- Insurance Fraud
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