Public Service Frauds At Otago District Health Board Essay

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.

Appendix A.2 also lists several factors that could provide opportunities for management/employees to commit fraud. One factor that could lead to fraud is if, “There is ineffective monitoring of management as a result of: domination of management by a single person or small group without compensating controls.” The auditors should have taken notice of the lack of controls and segregation of duties with respect to Phar-Mor’s

Audit failures are unfortunate for any health care organization and failed audits are due to financial statements falling under lack of

The amount listed is the enrollment agreement was 10,020.00 which gives a difference of :

Fraud is a serious crime that should concern all parties of the U.S. health care system and is a costly reality that the government cannot overlook. While not all fraud can be prevented, by learning about the many different types of fraud, patients can be educated on how to protect themselves from fraud. If we use government programs to inform the public that they can be targeted, the dollar amount for these cases for fraud can be reduced. An informed public and a properly funded FBI will go a long ways in the overall crackdown of health care fraud.

This booklet is designed to serve as a guidance to concepts of fraud and abuse laws which affect the coding, claims management, charge master and bill reconciliation. It is important to understand the laws as a variety of health care providers’ payment and arrangement activities are prone to fraud which eventually result in criminal penalties and unethical behaviors in health services. To evade associated liabilities, employees should understand the fraud and abuse laws and compliance policies.

In a scheme based in New Jersey and set to spread to eleven other states, Sheila Kahl, admitted to participating is a $1 Million Dollar Medicare fraud scheme. Along with her accomplice, Seth Rehfuss, convinced senior citizens to get genetic testic. The two fraudsters received commissions based off of the quantity of test that were ordered. To escalate matters, the two fraudsters used craigslist to locate healthcare providers that would work with them. Additionally, the two fraudsters also paid kickbacks to the healthcare providers that signed off on the testing for the senior citizens. (Pressofatlanticcity.com," n.d.)

As we head into the next four years under the Obama administration, many Americans are hearing more and more about healthcare reform and what needs to be done to fix the ailing healthcare system. Part of the dramatic increase in healthcare costs is due to Medicare fraud abuse. Healthcare fraud is defined as making false statements or representations of material facts in order to obtain benefits or payment. Healthcare abuse is defined as practices involving the overuse or misuse of services, either accidentally or intentionally, for various reasons that results in overpayment. These acts may be committed by an individual person or an entity. Fraud and abuse exposes a person, provider, or entity to criminal and

Rising costs of healthcare is a valid concern for many households in America. A factor in the cost of healthcare insurance is fraud. Fraud is often very difficult to detect. The magnitude of healthcare fraud is unknown. Initial reimbursement and payment and billing timeframe of 90 days allows for fast payment of services, however, many times before there is an indication of fraudulent billing the company has closed up and moved on. Fraud in American healthcare, costs American’s millions perhaps even billions of dollars annually. Without doubt, behind every act of fraud lies a lapse in ethics. This paper will review several pieces of literature to look

Healthcare fraud is costly for everybody, as it harms the reputation of the institution or physician committing it, and financially damages the patient being affected.By definition fraud may be defined as intentionally employing surprise, trickery, cunning, deception and unfair ways by which one party cheats another party out of financial resources. In order to educate a healthcare manager regarding fraud , many aspects of fraud must be assessed. This includes the types of fraud, the consequences that come with fraud,the individual(s) committing them, techniques to prevent fraud, and why the healthcare industry is vulnerable to fraud.

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.

The ODHB, historically known as HealthCare Otago, was reformed as one of 21 DHBs on 1st January 2001 under the New Zealand Public Health and Disability Act 2000. Accordingly, it was a government-funded sector located in Dunedin with the aim to support healthcare providers and promote the well-being of the population (NZ Parliament, 2009). On 1 May 2010, Southern District Health Board was established succeeding the merger of Southland and Otago DHBs (Southern DHB, 2010).

Rittenburg, Larry. Johnstone, Karla. Gramling, Audrey. (2012) Auditing: A Business Risk Approach 8e. Mason: South-Western, Cengage Learning.

Alliance Health + was established in August 2010. It is wellbeing and administration association. As the main Pacific-Led Primary Health Organization in New Zealand, AH+ has an enlisted Population of 93,000 crosswise over 26 General Practices in the Counties Manukau and Auckland DHB regions. (alliancehealth, about-us, 2015). AH+ (Alliance Health +) is a new organisation with all the available services. They also supports pacific provider network. It will be beneficial to New Zealand in the near future. The association additionally gives wellbeing and group administrations - especially in the territories of wellbeing administration combination, and of intersectional joining where that will impact the social determinants of wellbeing. We trust that accomplishing this will advantage all Population aggregates and will likewise enhance the working existences of clinicians and their capacity to better address the issues of the populations they serve. (alliancehealth, about-us, 2015)

A business can not work out without an account system, which includes internal. Internal controls are used by companies to make sure financial information is accurate and valid. Strong internal controls are signs of a financially healthy company and protect the company’s integrity. Strong internal controls can also increase a company’s profitability. There are several types of internal controls that companies used to protect themselves such as: Segregation of duties, asset purchases, supervisor review, internal audits and adequate documents and records. This paper will discuss several topics from a case study about And the Fraud