Abstract— Fraud in insurance health care brings significant financial and personal loss on individuals, business, government and society as a whole. The size of health care sector and the enormous volume of money involved make it an important fraud target. The big data trend, (the growth in unstructured data) always leaves lots of rooms for a fraud going undetected if data is not analyzed properly. Performing big data analysis can identify repetitive errors that are hidden and prevent the occurrence
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INSURANCE LAW PROJECT | HEALTH INSURANCE AND REGULATORY ISSUES UNDER IRDA ACT 1999 | Rudresh Pratap Singh Roll No. 49 Semester V RMLNLU | Contents INTRODUCTION 4 The Insurance Regulatory and Development Authority 5 Regulatory issues in the health insurance business 5 It should be the duty of the regulator (IRDA) to ensure that the new entrant in the health insurance sector: 5 II. Regulations Pertaining To Consumer
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AIG AND GENRE FRAUD ACCOUNTING FRAUD American international group was world's largest insurance company in 2007. Number of employees were 93 thousand and business was spread across 130 countries. Head of the organization was Maurice Greenburg. AIG had 95.8 billion outstanding equity shareholders to whom premium paid was 59.8 billion. General Re was world's largest reinsurance company. Genre was established 1921 , was owned by Warren Hathaway but led by Ronald Ferguson. AIG
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made into law on March 23, 2010. It took effect on January 1, 2014, when eligible citizens could access services as provided by the law. Some of the changes brought about by the law included expansion of Medicaid insurance, individual and employer responsibility and state health insurance exchanges operationalized, and the flow of individual and small-employer group subsidies (Hall & Lord, 2014). This law aimed at reducing the number of uninsured individuals to ensure every American citizen could
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| Internal Auditing in Not-For-Profit Organizations | TABLE OF CONTENTS ABSTRACT: 2 INTRODUCTION 2 SECTION I: CORPORATE GOVERNANCE 3 1. Corporate Governance Reforms Relevant to NPOs 3 2. Audit Committees of NPOs 4 SECTION II: RISK MANAGEMENT 6 1. Absence of Risk Management in NPO 6 2. Reasons for Risk Management in NPO 7 3. Process of Risk Management in NPO 9 SECTION III: INTERNAL CONTROLS 10 1. An illustrative example 10 2. Good Internal Controls 11 3. Strengthening Internal
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future health care system will be unable to run efficiently, if at all. In the private sector, Medicare has had a sufficient increase in Medicare Advantage, making managed care more important and placing the fee-for-service system at a great risk. One method for halting the rise of health care spending is to stop fraudulent claims on Medicare and Medicaid. “The U.S. loses at least $60 billion to health-care fraud every year, and some estimates put the cost as high as 10% of the nation's total health-care
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illnesses. The hospital will benefit from this trend since the federal government is in the process of asking manufacturers to subsidize the prices of specialty drugs. The free web-base electronic health records will bring transparency in the health sector as far as the cost of healthcare services is concerned. Since the EHR includes the financial information of how doctors charge, patients will be able to compare their fees with other institutions and make informed decisions. The costing of health
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is one of the least effective amongst developed nations? I will be reviewing, comparing, and contrasting four of the most well-known and most well established single-payer health care systems around the world. This includes: The National Health Insurance from Taiwan, Medicare from Australia, Medicare from Canada, and the United Kingdom’s National Health Service. Single-Payer First off, what is a single-payer health care system? It is a term used to describe the type of financing system, which
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Fraud Detection and Forensic Accounting ¨ Fatma Ulucan Ozkul and Ayse Pamukcu ¸ ¸ 2 2.1 Definitions of Fraud A quick search for the meaning of fraud in the dictionary states that fraud is “deceit, impersonation with intent to deceive, criminal deception done with the intention of gaining an advantage.” The Institute of Turkish History explains the word fraud as “a deceptive trick, scam, game, artifice, cabal which is committed to cheat, mislead someone” and “contributing something useless
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3. Financial Institutions: Banks are the major operations in financial markets and are the most important funds for a business. Investment banks are one of the fastest growing sectors of the financial markets and provide specialised advice and services for business financial needs. Finance and life insurance companies are non-bank financial institutions and act
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created to make health insurance more secure and reliable and most importantly accessible to all Americans according to Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS). It was also created with the intent of providing new ways to bring down costs and improve the overall quality of care. Secretary Sebelius has also identified six objectives for the new health care plan. (HHS.gov)i Objective A: Make coverage more secure for those who have insurance, and extend affordable
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fires on purpose, in order to relieve stress or for instant gratification. Some arsonist are pyromaniacs who start fires just for the thrill of it. Another reason arsonists start fires is for insurance fraud or reasons to do with money. People will burn or have someone burn down their house to get an insurance claim out of it. Also, failing business owners may have their store or warehouse burned down for the same reason. Arson incidents require certain people to investigate the fire. They investigate
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payments that affect your Social Security disability benefits. Workers' compensation payment is one that is made to a worker because of a job-related injury and illness. It may be paid by federal or state workers' compensation agencies, employers or insurance companies on behalf of employers. Public disability payments that may affect your Social Security benefits are those paid under a federal, state or local government law or plan that pays for conditions that are not job-related. They differ from workers'
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regulation and they defend their view by appealing to our right of individual freedom. The scope of government regulation of health services is disputed on a broad scale ranging from the advocation of complete government control of the health care sector to an almost completely hands-off policy in which it is left entirely to actors in the free market to provide these services. Despite the wide range of views, health care has been socialized, to a greater or lesser extent, in all modern, industrialized
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crime has grown, and even has jumped 45% between 2002 and 2003. Today it is used to investigate a wide variety of crime, including child porn, fraud, cyberstalking, murder and rape. The discipline also features in civil proceedings as a form of information gathering. As many of the computer crimes computers show the electronic environment in which frauds are programmed and executed. A example in which can be the transfer of money balances in accounts to random peoples accounts for withdrawal. Computers
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an in case they are not happen wit the portfolio they can withdraw at short notice Diversification An investor under takes risk if he invest all his funds in a single scrip. Mutual fund invest in number of companies across various industries and sectors. This diversification reduces the riskiness of the investment. Research Mutual funds can appord
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the fastest growing sectors in the Australian financial system, providing services in both borrowing and lending, primarily to the business sector. Finance and life insurance companies - are non-bank financial intermediaries that specialize in smaller commercial finance. Finance companies provide loan to business and individuals through consumer hire-purchase loans, personal-loans and secured loans to business. Superannuation funds - provide funds to the corporate sector through investment of
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and report unapproved endeavors to import, own, store, advance, or transmit nuclear or radiological material for utilization against the Nation, and to further upgrade this capacity after some time. FEMA’s Division deals with the National Flood Insurance Program (NFIP) and executes an assortment of programs approved by Congress to decrease losses that may come about because of natural disasters. With regards to the Federal Law Enforcement Training Center (FLETC), the organization of Training Management
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Chapter 2 The Health Reform Cycle 1. Introduction In Chapter 1 we introduced the idea that health sector reform can be viewed as a cycle. Now we want to analyze that process in more detail. In idealized form, the process of policy change moves through a cycle of six stages—problems are defined, a causal diagnosis is made, plans are developed, a political decision is made on reform initiatives, those reforms are then implemented, and their consequences are evaluated. The cycle then begins again
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the Fourth of July holiday. Organization The restaurant will serve several market sectors. It will have a family atmosphere as well as to cater to the sports enthusiast. The restaurant will have a lunch menu, dinner menu, and the bar menu. The restaurant will also have weekly happy hour drink specials along with lunch and dinner specials for the casual shopper. To prevent a rise in insurance cost and prevent insurance claims management will stress and enforce the importance of safety, which begins
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and regulations that apply to businesses. Large or small, corporations or mom-and-pop shops, profit or non-profit; all of these types of businesses are run based on ethical obligations that they have to their customers, employees, and the business sectors. Some of the ethical dilemmas a business may face are fairly simple to resolve, while solutions are not so black and white. In this article, I will examine both a profit and not-for-profit organization. I will provide details on their company’s
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details for this application 3 2. About the applicant 4-5 3. Companies House registration information 6 4. Additional locations and business activities 7–8 5. Individuals involved in the business 9 – 15 6. Sectors and turnover 16 – 17 7. Relationships with others 18 – 20 8. General compliance and marketing 21 9. Application fee 22 10. Declaration 23 Claims Management Regulation – Application for authorisation (04.12)
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Management, and Insurance Introduction When faced with the possibility of a loss, it is important to begin by understanding exactly what risk exposures are involved how the losses might occur, and how these losses might be prevented or reduced before deciding to insure against them First Principle: Law of Large Numbers explains how insurers can figure out how much to charge different classes of insureds. Second Principle: AN insurance policy is a contract. The insurance industry holds 7
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PUBLIC SECTOR PRIVATISATION 2 2.1 Improving Efficiencies 2 2.2 Reduction in Government Cost and Spending 3 2.3 Focusing on Core Competences 3 2.4 Streamlining Businesses to Allow Productive Job Creations 4 2.5 Obtaining Goal Congruences 4 2.6 Effective Utilization of Taxpayers’ Money 5 2.7 Generate Income Tax Revenue 5 2.8 Improving Government Financing 6 2.9 Reorganisation or Restructuring Government Systems and Performance Measures 7 3.0 DISADVANTAGES OF PUBLIC SECTOR PRIVATISATION
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FA363 Auditing Module Answers (May/June 11) Question 1 (a) Fundamental accounting concept that the accounts of the company are assumed to be prepared on a going concern basis This means that the business will carry on its activities in the same way ie there will be continued sales, supplies and sufficient cash to base the business Foreseeable future vague but usually considered to be between three and five years If the company is not a going concern then the directors have a responsibility
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process: fair process (appealing) d. Job expectancy rights (fair and equitable employment) i. Employee info and access to it * Privacy: Privacy act, PIPEDA & Quebec: act respecting the protection of personal info in the private sector. * Info can only be collected when necessary purposes, fully inform, written permission is needed to disclose the info the 3rd parties. * File: kept in HR, employees have the right to see the contents ii. Searches and surveillance
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conspiracy and lying about a stock sale, and served five months in prison. Founder Samuel Waskal, who advised friends and family to sell stock and attempted to sell his own stock prior to the announcement, pled guilty to charges of bank fraud, securities fraud, obstruction of justice and perjury. He was sentenced to a seven-year, three-month prison sentence in 2009, but was released in 2009. Apart from the direct impact brought by manipulation of stock markets, some other financial activities that
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flexibility of the Accounting Quality Model is paramount in the SEC’s continued commitment to the proactive detection of fraud in accounting and financial disclosures with the creation of two new initiatives by the current SEC Chairman, Mary Jo White. The SEC announced in July 2013 the creation of two new task forces, the Financial Reporting and Audit Task Force (FRAT) and the Mircocap Fraud Task Force (MFT). Recommendations for compliance include the following: file accurate XBRL reports; implement conservative
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into computer related crime. Retaining highly trained individuals within the CJS is critical. The prospects of better salaries and conditions within the private sector often lure some of these people away from the CJS. Either government needs to allocate increased budgets for the investigation of economic crime or else the private sector will need to work cooperatively with law enforcement to conduct its own investigations (Smith, 2001). Funding of adequate resources for training and equipment
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consumes medical care services. Financial Incentives Hippocratic Oath Few Scientific Studies Medical Malpractice Lawsuits/Defensive Medicine Physician Desire to Help Patient 8. List 3 of the 4 categories that most Americans without health insurance fall under. Working poor and employees of small businesses Young and healthy Temporarily unemployed Free-riders 9. List 3 reasons for the relatively low quality of medical care in the U.S. 10. List 3 reasons why many doctors don’t use evidence-based
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