1. Introduction
On 1 January 2001, District Health Boards (DHBs) were established under the NZ Public Health and Disability Act 2000 (Kloosterman, 2010). There were a total of 21 districts health boards and Southern DHB is the first board formed as the result of the combination of two districts, Southland and Otago DHBs (Southern District Healthboard). SDHB was formed on 1 May 2010 and is responsible for most publicly funded primary health and hospital services in those two districts with a population of over 315,000 (Kloosterman, 2010).
This report investigates the biggest fraud case committed by a state employee against a Government institution in New Zealand (Otago Daily Times, 2008), Otago District Health Board, which went
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Sonnford Solution that was formed by Harford was alleged by the Serious Fraud Office (SFO) that the company only acted as a front for their well-planned fraud (McDonald, 2009) had charged the company 198 invoices over the six years period for supposedly insurance-type services related to the provisions of IT licenses, services and support that was never provided by the company to the hospital (Peart, Otago Health Board fraud investigation: $16.9m siphon went unnoticed for years, 2008). SFO counsel, Robin Bates, said that Swann and Harford had an agreement where Harford would prepare the invoices; Swann would sign them off and then pass them to the board’s accounts department for payment. 10% of the amount (in total $1.7 million) was received by Harford and the remaining 90% ($15.2 million) was given to Computer South Company which was under Swann’s control (Peart, Otago Health Board fraud investigation: $16.9m siphon went unnoticed for years, 2008). There was also a corrupt payment charge against Swann and Sew Hoy, the owner of Innovative Systems Limited. In between 14th January 2000 and 3rd November 2006, Innovative Systems Ltd received almost $5 million from ODHB for the services and consultancy provided in which the company paid $757,684.89 to Swann’s company. However, there were no invoices generated by Computer South Ltd and there was no justification for any payment by Innovative Systems to Computer South (NZPA, 2007).
The case of Rita Crundwell revolves around a town, other employees, and an auditor 's blind trust in a women, who clearly did not deserve the trust. Crundwell was the town Comptroller. The fraud resulted in 53 million dollars to be siphoned from the town 's funds in a time frame of 20 years. Crundwell covered her tracks with a fake bank account, fake invoices, and the party line of blaming the state for simply being behind on payments. There were many red flags during the two decades of this scheme, but due to the town 's small size and trusting attitude, they relied heavily on external audits, which were not up to par.
Western Health System noticed that many of its local clinic managers were leaving to join the competition. Their human resources director, Stephanie Anderson realized that they were losing a lot of talented people who had become demotivated, and she worked on developing a program to increase their motivation in hope that they would remain committed to Western Health System. Her program, Exploration, had many great features, but to truly asses the program one first has to understand motivation, motivational theories, and the current issues at hand.
In the news recent was the Miami physician pleads guilty for role in $20 Million health care fraud scheme (Justice. Gov). The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida (Justice.
Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).”
The Kentucky Cabinet for Health and Human Services is entrusted with the oversight of the mental and physical health of the citizens of Kentucky. This agency is responsible for the oversight of senior, children, adult, and family health. It also coordinates activities with the federal government, in the form of the state Medicaid program, the health insurance program for the poor which is state-run but dependent upon funding from the federal Department of Health and Human Services and tracks patterns of disease determined significant by the Centers for Disease Control (CDC). "The Cabinet for Health and Family Services (CHFS) is home to most of the state's human services and health care programs, including Medicaid, the Department for Community Based Services and the Department for Public Health. CHFS is one of the largest agencies in state government, with nearly 8,000 full and part-time employees" (About CHFS, 2013, CHFS). Some of its programs are specific to the state of Kentucky, such as KinCare which assists grandparents who are caring for their children as primary caregivers and Presumptive Eligibility "a program that enables eligible pregnant women to receive prenatal care through Medicaid for up to 90 days while their eligibility for full Medicaid benefits is determined" (Adults CHFS, 2013, CHFS).
Freeman, M. (2012). Chapter 91: The Bell Tolls for Local Government Corruption. Mcgeorge Law Review, 43(3),
Health Bureau is a field in the healthcare field that is not always appreciated by some people, however; many Health Bureaus are found in large cities with a majority of people seeking help and services from the health bureau. Public health workers have two main roles in the community the personal side and environmental side. Personal side of public health main role is to go out into the community and talk to people about what can be improved in the community. Then the public health worker go back to the office and try to get a make a grant so they can provide services that people ask for. If their grants get approved public health workers think of ideas to get people out into the community to see these programs. These programs that public
Despite selfless goals, whistleblowers face quandaries on their professional and individual levels. Contemporarily, the bulk of current central health care fraud suits are qui tam actions (Ruhnka & Boerstler, 2000). Such actions have resulted in recovery of substantial amounts of government funds from fraudsters.
Services Administration (HRSA) under the Department of Health and Human Services (HHS) (Knudson, Gibbens & Fischbach, 2014). These services have a wide responsibility for analyzing the effects of policy on rural communities and helps shape rural health policy in a variety of ways.
The budget proposal for the Department of Health and Human Services was presented by Director Richard Whitley and Acting Administrator from the Division of Health Care Financing and Policy, Marta Jensen. In the first part of the presentation, Whitley presented a basic outline of the functions of the Department of Health and Human Services (DHHS). In terms of the Upper Payment Limit Program (UPL), Chair Sprinkle wanted Whitley to confirm that DHHS was moving its contract services from non profits for financial reasons. Whitley confirmed this and elaborated more by bringing an example of the situation with the newborn screening program. Originally, Nevada paid the state of Oregon to operate that program, however over time that was transferred back to the state of Nevada. As a result,
The Federal Bureau of Investigation is spending large amounts of its budget to crack down on health care fraud. Special units have been formed to help the FBI Crimes Section find these criminals and take them to court to seek proper punishment. Crimes are being committed by both providers and insurance companies on a daily basis. Moreover, their patients and subscribers are
Fraud in health care is a major issue, even with all these laws and rules on how on to comply. Here are some of my example on overt, covert, and occult fraud inside the health care system.
SJCPHS hosted external stakeholders to evaluate the strength of the public health systems as a step towards accreditation. Many different organizations contribute to the structures that influence public health. I compiled the contact information into a database for invitations. During the actual evaluation, I assisted in the preparation of the event. Throughout the day, I co-facilitated discussions with senior staff from the health department. Participants provided feedback about laws, coalition efforts, and research practices. They also rated efficiency levels of the different core functions. I worked with my host site supervisor to collect artifacts and ensure that the process complied with guidelines provide by the CDC and NACHO.
Combating fraud in the private sector is a difficult task. Trying to combat fraud in the public sector is daunting. In 1999 15.7% of the American workforce were employed by a government entity (federal, state, and local).[1] Mirroring society, government will have its share of perpetrators. The difference from the private sector is in the scope of the fraud committed, the loss of the public trust, the blaring headlines from news media, and difficulty in making necessary changes to combat the problems.
With the avalanche of accounting scandals that have rocked the public, people tend to have increasingly high expectation that auditors are accountable for detecting all frauds, while the standards require auditors to provide reasonable, but not absolute, assurance. The purpose of the report is to discuss the accountability of auditors in detecting fraud by analysing a $16.9 million fraud of Otago District Health Board (ODHB) perpetrated by Swann and Harford from 2000 to 2006. The report will explain the event, the fraud, the stakeholders, the role of auditors and the current situation.