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Kickbacks aren't the only way to draw people into fraud schemes: From overstuffed chests to overstuffed seating, criminals use gifts and incentives--including Disney vacations--to reel in a steady stream of insured customers.
The challenges of controlling prescirption drug-related fraud are clear as these schemes continue to make news.
Shell companies should be a concern for health payers because criminals use these companies to launder money and facilitate fraud, according to an article in this month's issue of Fraud Magazine.
Fraud schemes have kept law enforcement agents busy in Florida, where recent news focused on actions against recruiters and those who hired them to round up customers for health insurance scams.
Sharing stories about fraud schemes, criminal prosecutions or recovered money can contribute to a special investigations unit's visibility and success.
Have you heard of the fraud triangle and diamond? The fraud triangle, developed by sociologist Donald Cressey, is a model explaining three factors that lead people to commit fraud: Pressure (or a...
Creating and maintaining a tool to monitor fraud vulnerabilities may improve the control environment and help payers address risk proactively, according to a Fraud Intelligence article by Mike Sherrod, CFE, CPA.
At the National Health Care Anti-Fraud Association's Annual Training Conference in Orlando, Fla, Jennifer Trussell, special advisor with the Office of Investigations at the Office of Inspector General outlined seven fraud trends that government and private health insurers must keep an eye on.
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