Term
| The size of the Health Care Industry |
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Definition
| In 2007, 2.26 trillion was spent on health care and there were over 4 billion health insurance claims processed over that year. |
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Term
| How much fraud occurs in the Health Care Industry |
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Definition
| Conservative estimates out health care fraud at 3% or 68 billion. Looser estimates go as high as 10% or 226 billion. |
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Term
| How people are physically hurt by Health Care Fraud |
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Definition
| People can be subjected to unsafe or unnecessary medical procedures. Medical records may also be compromised/falsified to better fit in with fraudulent claims. |
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Term
| Who commits Health Care Fraud? |
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Definition
| The majority of cases are committed by a dishonest minority of health care providers. |
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Term
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Definition
| A health care fraud tactic of billing each step of a procedure independently. |
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Term
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Definition
| A health care fraud tactic of billing for a higher priced treatment than what was actually provided. This can accompany tampered medical records. |
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Term
| Difference Between Direct and Indirect methods of proving income. |
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Definition
| With direct, you already know the source of the income, you're just trying to see where it's going. With indirect, you don't know for sure if any money has been stolen so you look at what they're spending and then subtract their income to find out if they can afford their expenses. If they aren't they probably are fucking around. |
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Term
| Indirect Methods of Proving Income |
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Definition
| Bank Deposits, Net Worth, Expenditures |
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Term
| Three Steps of Money Laundering |
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Definition
| Placement, Layering, Integration |
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Term
| Money Laundering - Placement |
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Definition
| The firs step of money laundering. The money has to be put somewhere. This can be a bank account or possibly the transferal for assets or new bills. Money Launderers are most likely to get caught at this step. |
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Term
| Money Laundering - Layering |
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Definition
| Move the money around so that it eventually shakes its identity as dirty money. For example you could attach the money to false documents, i.e. sales invoices or loan documents that indicate legitimate source of funds deposited |
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Term
| Money Laundering - Reintegration |
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Definition
| The final step of Money Laundering. Putting the money back into society. |
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Term
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Definition
| Money laundering is the practice of disguising illegally obtained funds so that they seem legal. |
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Term
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Definition
| An officer who examines accounts and verifies the accuracy of the statements therein. |
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Term
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Definition
Evaluate Internal Management Control
Analyze Financial Performance
Measure Program Effectiveness
Measure Management Efficiency
Provide Oversight |
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Term
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Definition
Categorize Financial Transactions
Measure Income and Expenses
Evaluate Assets
Calculate Profit and Loss
Tax Liability
Issue Financial Statements. |
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Term
| The changing roles of Accountants and Auditors . |
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Definition
| Traditionally, Accountants and Auditors did not act as Fraud finders but that is changing nowadays. |
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Term
| Key Points of Sarbanes-Oxley Act |
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Definition
The Sarbanes-Oxley ACt put greater restrictions on Accounting. It created a public accounting oversight board. Extends statute of limitations for discovery of fraud to two years from date of discovery and five years after the act. Prohibits company officers, directors and other insiders from selling stock during "blackout periods".
Extends Whistleblowers protections to accounting firm employees. Makes it felony to knowingly destroy or create documents in order to obstruct investigation |
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Term
| Objectives of Money Laundering |
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Definition
| Primary: Promote the illegal activity that spawned the dirty money. Conceal or disguise the nature, location, source, ownership or control of dirty money. Also: Tax evasion, change its character to to allow spending and investing. |
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Term
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Definition
| Use all branches available on a case. |
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Term
| Currency Transaction Report |
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Definition
| Any cash transaction in excess of 10k during the same business day. Filed with the IRS |
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Term
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Definition
| Offered a greater reward for whistle blowers and allowed whistle blowers to sue their companies. |
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Term
| Methods of Obtaining Documents |
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Definition
| Voluntary Consent, Public Records, Subpoenas, Searches |
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Term
| Different Types of Subpoenas |
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Definition
| Court (Trial) Subpoena, Subpoena ad testificandum (testimony), Subpoena duces tecum (to produce documents or other items), Administrative Subpoenas (only for documents, 0 secrecy) |
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Term
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Definition
| Better than subpoena as they catch the suspect off guard. They also provide opportunity for employee interviews. Can only be obtained in conjunction with probable cause that a crime has occurred. |
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Term
| Tactics of the Defense Attorneys |
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Definition
| Delaying each and every step, subpoenaing, searching, and warrants. They will go to the press and try to get the public on their side. Convince the opposition of the defendant's worth, and ensure that the investigation is done fairly. |
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Term
| Types of Health Care Fraud |
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Definition
| Billing for services that were never rendered, upcoding, performing unnecessary services for additional funding, unbundling, general lying. |
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Term
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Definition
| Requires USA financial institutions to assist US gov agencies to detect and prevent money laundering. |
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Term
| Implications of Bank Secrecy Act |
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Definition
| Banks must keep records of cash purchases of negotiable instruments, and file reports of 3,000 or more per day. |
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Term
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Definition
| A CTR Currency Transaction Report, must be filed on any transaction that occurs that totals over 10,000 dollars. |
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Term
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Definition
| CMIR Currency or Monetary Instruments. Anyone who interacts with cash or traveler's checks must be recorded. |
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Term
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Definition
| FBAR Foreign bank & Financial Account Report. All staff within a bank who have accounts of value greater than 5k must file a report. |
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Term
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Definition
| A log of purchases of monetary instruments that exceeds 3,000. The record must be kept for 5 years. |
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Term
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Definition
| Alternative forms of currency; money orders, traveler's checks, and cashier's checks. |
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Term
| Public Accounting Oversight Board |
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Definition
| Created by the Sarbanes-Oxley Act. It includes five member 2 CPAs and 3 non CPA. It sets audit standards for public companies. Inspects operations of accounting firms that audit public companies. Has the power to impose disciplinary/remedial actions for violations of board's rules, securities laws, or auditing standards. |
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Term
| Why do white collar criminal often not get substantial jail time? |
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Definition
| Lack of violence in their crime and they often do not have criminal history. |
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Term
| Federal Sentencing Guidelines |
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Definition
| This has been in effect since the mid 1980's. There are offense levels 1-25, and then there are tweaks. So if you have a base crime of armed robbery at 20, if you're just an accomplise it may drop to 19, but if someone is injured it may go up to 22. The X-Axis is priors 1-5, the more priors the closer to 5. |
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Term
| Sentencing for Organizations |
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Definition
| In 1991, the sentencing commission established sentencing guidelines for organizations, this was directed at companies and not for people. |
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Term
| Organizational Sentencing |
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Definition
| The theory was that if you could detain crime by rewarding no priors for people, the same can be done for corporations. Think Carrot and Stick. |
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Term
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Definition
| A judge could sentence a company to a 2 Million dollar fine over a probational period. If a company stayed out of trouble for the probational period, they get their money back. |
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Term
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Definition
| If the defender's conduct can be described as inherently evil in 30 seconds, go after him |
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Term
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Definition
| Prosecuting a guy who is so pathetic that it looks like the government is teaming up on a weak guy |
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Term
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Definition
| If the potential defendant is represented by really expensive counsel, then sue him. Most people won't pay that much for problems they do not have. |
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Term
| Freedom of Information Act |
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Definition
| If an agency has information on you they have to keep it private to a degree. You also need to have access to any and all information about you. The government must disclose information to people that request it. |
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Term
| Fair Credit Reporting Act |
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Definition
| Information cannot be disclosed to media personnel without letting the investigators know that the investigation is commencing. |
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Term
| Right to Financial Privacy Act |
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Definition
Intended to protect financial privacy.
Federal agencies and investigators cannot informally go to a bank and request information. It must be done with subpeonas. |
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