Category Archives: Economy and Meltdown

The Five Anti-Fraud Strategy Plan

Fraud is a growing concern for all businesses with many affected each year, whether they care to admit to it or not is another matter. The key to reducing the chance and therefore the impact on your organisation in terms of lost money and potentially getting a bad reputation is to have an effective internal control system.
There are five anti-fraud points that companies should implement starting with having a strong anti-scam stance, which should be felt across the whole organisation.
An Empowered Audit Committee
An audit committee is a necessity in a large organisation, especially if stakeholders aren’t part of management (both private and publicly traded). The committee needs to be aware first of all of the fraud risks that are present to the company as well as other potential risks of scams that may crop up in the future. The audit committee should work with management to understand the monitoring systems and how they are looking to mitigate those risks. A good committee must ensure they remain sceptical and investigate everything no matter how small.
Regular and Detailed Fraud Risk Assessments
Regular is really key, the threat will be significantly reduced if employees know that accounts and systems will be regularly assessed and will catch any outside fraud as soon as possible and hopefully before the scam does too much damage.  An effective fraud assessment should cover different fraud scheme scenarios that could be carried out, the people in the organisation that could carry out such schemes and the impact it would have on the organisation.
Educating Employees – Anti-Fraud policy
It isn’t uncommon for employees to abuse the company’s reimbursement policy or use the resources for their own gain which can go undetected and not seen as fraud however misuse of company assets is a waste of time and resources, costing the company. Fraud, in most instances starts out small so nipping this in the bud will eliminate many of the organisations problems. A fraudster will start with taking advantage of expenses then likely gain confidence and will start with other scams.
Organisations should implement a no tolerance policy in order to send the message to all employees that any type of fraud or misconduct will be severely dealt with.
Responding to Fraud claims
No matter the size of the organisation, every fraud allegation should be investigated as the potential effect on the organisation could be huge. A policy should be implemented, a hard print that the organisation will follow for collecting evidence, the responsibilities that each department and managers have and who will be informed depending on the severity of the allegation.
Effective Reporting System
Firms should all have a hotline to report scams they have encountered or suspect. Using a hotline is one the easiest for both employees and the business to operate and is also the least expensive way for reporting potential scams.
Regular review of the hotline should be conducted to ensure it is as efficient as possible either by management or a third party. The hotline shouldn’t be limited to employees. To cover any potential fraud the number should be external to cover customers and suppliers too and if the business is global it should operate 24/7. As part of employee training, the types of activities employees should watch out for and report should be included.
For more in depth of anti-fraud schemes and scam prevention then I’d suggested attending a dedicated conference such as the  conferences.

Kim enjoys writing articles on how to keep safe online. To find out more visit Marcus evans scam conference.

Medicare and Medicaid Fraud: US Healthcare Reform

Medicare and Medicaid fraud in the US has been growing in dollars for many years and is receiving a lot of discussion as the Universal Health Care bill has been signed by President Barack Obama. Medicare is a government program that provides medical coverage to the elderly in the US and Medicaid provides for the poorest in the country.

Reported in the Reuters article “”:

“An estimated $54 billion was lost through improper Medicare and Medicaid payments in 2009. Obama is seeking to crack down on waste and fraud as his administration strives to secure an overhaul of the $2.5 trillion healthcare system to contain costs and expand coverage to tens of millions of more Americans.”

As stated in the , on March 10, 2010, there was an expansion in the use of “Payment Recapture Audits,” which is a process where highly skilled accounting specialists and fraud examiners use different tools and technology to examine payment records and uncover problems such as duplicate payments, payments for services not rendered, overpayments, and fictitious vendors.

Medicare/ Medicaid Abuse

In 2009, Bernie Sanders, US Senator for Vermont pushed hard to include the “fraud crackdown” in the healthcare reform bill. Sanders wanted to significantly increase, and even double the fines faced for those facing penalties for committing health care fraud. Sanders outlined the following cases that made it to court and contribute to the need for tighter restrictions on the medical insurance industry in the US:

  • Earlier this year, a jury found Pfizer owed Wisconsin $9 million for violating the state Medicaid fraud law more than 1.4 million times by purposely overcharging the state for prescription drugs. The company faces potential fines from $140 million to $21 billion.
  • Also in 2009, UnitedHealth, a leading insurance company, paid $350 million to settle lawsuits brought by the American Medical Association and other physician groups for shortchanging consumers and physicians for medical services outside its preferred network.
  • In 2003, GlaxoSmithKline paid $88 million in civil fines for overcharging Medicaid for its anti-depressant Paxil.
  • Also in 2000, Humana paid $14.5 million to settle federal charges of overcharging government health programs.
  • In 2000, the Hospital Corporation of America agreed to pay $745 million to settle civil charges that it systematically defrauded Medicare, Medicaid and other federally-funded health programs.

Easy Target

Reviewing various fraud cases involving Medicare and Medicaid makes me wonder how these people are getting away with stealing large sums of money- until I learned this:

“Medicaid and private insurance companies are also struggling with fraud. But there are a few factors that make Medicare almost a perfect target. One is that it’s a trusting system, set up to serve honest physicians — with few safeguards designed to weed out false claims. Also, most claims are paid automatically, so there’s little or no person-to-person contact.”

Verification of fraudulent claims has become sacrificed due to the goal of providing faster turnaround times for processing claims and getting money back to claimants- this makes it easier for fraudulent claims to go unnoticed. These types of fraud make health care more expensive than it already is in the US, forcing the government to take action and crackdown on those abusing the system in order to ensure that these costs are no longer passed on to the public.

Here is a list of the common types of  Medicare fraud:

  • A health care provider bills Medicare for services you never got.
  • A supplier bills Medicare for equipment you never got.
  • Someone uses another person’s Medicare card to get medical care, supplies, or equipment.
  • Someone bills Medicare for home medical equipment after it has been returned.
  • A company offers a Medicare drug plan that hasn’t been approved by Medicare.
  • A company uses false information to mislead you into joining a Medicare plan.


The White House claims that correcting the fraud that surrounds Medicare and Medicaid claims could double taxpayer savings over the next 3 years- providing a savings of at least $2 billion. The New York Times reports that “White House officials said that a pilot program run by Medicare in California, New York and Texas recaptured $900 million in taxpayer money between 2005 and 2008.” A common trend that links the proposed investigation solutions is the increased use of technology to detect suspicious billing patterns and keep track of service providers with a track record of problems. Technology upgrades also extend to patient files, as another part of the healthcare reform is to computerize patient charts to allow for electronic filing as opposed to paper systems.

The focus on integrating technology into the fraud and insurance claims industry is not new- as you can see this is an urgent matter and some cities have already started targeting medical insurance fraud. There are time and money saving solutions, such as i-Sight Investigation Software, that make it easier to conduct inquiries and investigations into fraudulent claims. The “Payment Recapture Audits,” that will be conducted by highly skilled accounting specialists and fraud examiners, can become a less daunting task when an investigation software solution is implemented. Some of the features of i-Sight, such as the ability to identify and track repeat offenders, make it easier to catch and stop those committing the fraud before it’s too late. If the same individuals, groups or businesses have a history of submitting false or bogus claims, each time a case is made involving them, you will have to tools to refer back to previous events and put an end to their actions.

Success With i-Sight

With i-Sight, we provide investigations case management solutions for insurance companies to assist in catching fraudulent claims before they are processed and paid out. One of our clients, the , Inc. has implemented i-Sight Investigation Software to improve their ability to track, manage and analyze investigations of insurance fraud and abuse in the healthcare industry. According to the General Accounting Office, approximately one-tenth of all U.S. spending on healthcare is lost to fraudulent insurance claims and other forms of abuse. The TriZetto Group realized that i-Sight was a perfect solution for tracking insurance based investigations as it’s fully customizable, conforms to laws and regulations that guide specific industries and saves them time and money through faster, more accurate investigations.

i-Sight is a case management software platform designed to simplify your process and provide outstanding reports. It’s primarily configured to manage customer complaints and corrective actions, or employee relations, HR & ethics investigations. It’s also used for a variety of other customized case management solutions. We blog at, providing advice and tips to HR managers and investigators in regards to managing internal investigations.

Why a Bad Economy Leads to Accounting Fraud

seems to escalate in a bad economy. There are many reasons for this, and some of them may surprise you. When the economy is bad, people become desperate to maintain their lifestyles, or even to just survive. Under these conditions, some people turn to fraud.

In a bad economy people do not make as much money, there are not enough jobs to go around, and the stress of trying to make ends meet can be overwhelming. Some people turn to fraud as a quick fix for their financial problems. There are many types of fraud, from the employee of a large corporation taking advantage of access to secure documents to investment fraud.

But why would people take such drastic measures, considering the severity of the consequences? If caught, criminals convicted of fraud can be subject to large fines and jail time. In a bad economy, these measures do not seem as drastic as the thought of losing one’s home or having to alter one’s lifestyle. Living beyond one’s means is a common financial ailment in America, one that quickly becomes severe with the economy goes bad.

Part of living beyond one’s means entails accruing a significant amount of debt. Things have to be paid for somehow, and the credit card has long been a best friend of those who wish to buy more than they can afford. Excessive debt can ruin a person’s lifestyle and may make someone more likely to commit fraud, especially in a bad economy.

Another drain on one’s financial resources that may lead to fraud is child support. Child support, and alimony, are often both taken directly out of one’s paycheck. This causes a significant decrease in the amount of money one is making, and can lead to desperate measures, such accounting fraud, in a bad economy.

Obviously not everyone with these hard to maintain lifestyles resorts to fraud, but the risk does increase in proportion to the amount of . Other contributing factors are personal, such as addiction, legal issues, or a criminal history. These circumstances all require an excess of money, and heighten the risk of a person committing accounting fraud in a bad economy.

While a bad economy does not guarantee that people will commit , the odds of it happening get higher as the economy gets worse. When people feel there is no financial way they can survive, many will resort to criminal behavior.

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Is Affiliate Marketing a Scam? Answers to Help You Decide

So you are asking, is Affiliate Marketing a scam?  If you are looking for way to make money from home I bet you have heard about Affiliate Marketing.  I bet you have seen the numerous websites, articles and ads telling you that you can make thousands of dollars a month selling other people’s products from the comfort of your home.  But is it real or is it just a scam?  Here is some information to help you decide.

To start, let’s define the word scam.  “To obtain money or other goods from somebody by dishonest means ” or “a scheme for making money by dishonest means.”  If you visit a website that tells you that you can make tons of money with very little or no effort, I would say that is a scam.  If someone is selling you a product or service that is guaranteed to make you rich, I would say that is a scam.  So, is Affiliate Marketing a scam?  The answer is not a simple yes or no.

Affiliate Marketing is a specialized form of internet marketing practice in which a business compensates one or more affiliate for each visitor or customer gained by the affiliate’s marketing efforts.   The simple answer to whether or not Affiliate Marketing is a scam is that the practice itself is not a scam, but there are people who will scam you using Affiliate Marketing.  For example, if someone were to promise that you could make money at Affiliate Marketing with little or no effort on your part if you buy their product or service, then that is a scam.  But if someone tells you that if you learn the techniques that will make you successful at Affiliate Marketing you can make money, that is not a scam.  Affiliate Marketing really does work, or there would not be people using scams to make money off of it.  If you are willing to put in the time and effort to learn the techniques of the trade, it will definitely pay off!

As with anything that you can use to make money on the internet, you need to use your best judgment to determine whether or not you are being scammed.   Remember that if it sounds too good to be true, it probably is.  I hope this helps you decide whether Affiliate Marketing is a scam or not.  Whatever you decide, I wish you the best of luck in your online endeavors!

I believe that anyone can be successful at Internet Marketing and I have designed my website to show you how!  Visit to learn more.  Click here for more information on how you can make money online and avoid scams!

Breaking Down a Scam Letter

Fighting spam is a daunting task, ask any anti-scam website owner, and they will tell you, it’s hard work keeping up with the scam emails out there. I believe the best defense is using a on Outlook and email server exchangers, but out in the free email account world, you need to rely on yourself to tell if that email from your “bank” is a real one or a fake.

So lets break down a recent email from a scam artist found on one of my favorite out there.

Dear Valued Customer:

We recently have determined that different computers have logged in your Bank of America Online Banking account, and multiple password failures were present before the logons. We now need you to re-confirm your account information to us. If this is not completed within 24 hours, we will be forced to suspend your account indefinitely, as it may have been used for fraudulent purposes. We thank you for your cooperation in this manner. In order to confirm your Online Bank records, we may require some specific information from you.

To restore your account, please Sign in to Online Banking

thank you for using Bank Of America Online Service.

Your account might be place on restricted status. Restricted accounts continue to receive payments, but they are limited in their ability to send or withdraw funds. To lift up this restriction, you need to login into your account (with your username or SSN and your password), then you have to complete our verification process. You must confirm your credit card details and your billing information as well. All restricted accounts have their billing information unconfirmed, meaning that you may no longer send money from your account until you have reactive your billing information on file. Sign in to Online Banking

Thank You.

Please do not reply to this message. If you have any questions about the information in this e-Bill, please contact your biller. For all other questions, call us at +44-800-887-5749.

Bank of America, N.A. Member FDIC. Equal Housing Lender

© 2010 Bank of America Corporation. All rights reserved


1. No matter what bank you have a account with, no bank is ever going to email you this sort of request. Never. They will have contacted you by phone or would have made contact with you via any other means other than a email. Remember that, because no matter what bank you use, you would never be asked to verify it in this way for the reasons stated.

2. Drag your mouse over the link supplied in the email, and look at the bottom of your browser, the address where you would be re-directed to doesn’t match up to the real website you should be directed to. This is also another important identification mark of the scam artist. Links they supply will typically never actually take you to the real website, unless they mess up in the formulating of the email before sending it to you, which has happened.

3. If this was a real email from your bank, they would have addressed you as Mr or Mrs Soandso, not with a generic “Valued Customer”. Most banks use software that title the email to the actual name of the account holder. This is another tell tail sign.

4. No local phone number. That is a great way to identify a scam email, simply because there is no way for them to know who is going to read this email, and where you might live. They are rolling the dice with this form of email, hoping you might actually have a account with this bank, and that you are not smart enough to know it’s a scam.
Also, if they had included a local phone number, would you be willing to call Nigeria about your bank account in the US? As they tend to use a redirect prefix of +44 before a number.

5. Grammar. This is a dead give away. 99% of the scam emails I have read over the years lack one important factor, professional language and writing. “To lift up this restriction” and “login into your account” are just two small hints out of the dozens easily seen in the letter. Do you think one of America’s largest banks is going to send out emails to their customers with more grammatical errors then a four year olds “What I did last Summer” essay?

6. Why would your bank want your SS# if you already are an account holder? Your bank would have this on file, and have no need to have you tell them for a second time.

7. The number one, most important piece of information I can point out is that if you did get this email, why would it be in your junk folder and marked as spam? Banks like this one pay a good sum of money to make sure their emails are never labeled as spam.

So there you have it, a few inside pieces of information from one of America’s biggest anti-scam experts. Take care in how you handle and read your emails, and always exercise caution!

Executive Chef and Restaurant Consultant of 22 Years Shares his Ideas and Information on many ranges of topics, from Single Fatherhood, Culinary, Computers and more. You can easily do a quick Google search of Chef Jeffrey Allen Kaufman and find numerous articles he has written. With his Democratic Political Influence to his random private recipes to his out spoken thoughts on subjects many won’t approach, you can be sure to learn a lot from his writings.