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2007
Fraud
Risk Management in Life Sciences Companies
December 2007: The Food and Drug
Administration (FDA) estimates that counterfeit products make up
more than 10 percent of the global pharmaceuticals supply.
Altogether, the global market in sales of counterfeit drugs is
estimated by the World Health Organization to be more than $32
billion annually, and the U.S.-based Center for Medicine in the
Public Interest predicts that counterfeit drug sales will reach $75
billion globally in 2010.
Whether it takes the form of
counterfeit products slipping into the supply chain or involves
employees of your company engaging in unlawful pricing activities,
fraud costs life sciences companies billions of dollars annually.
The direct costs – settlements with third parties and the related
defense costs – don’t include the more difficult to measure, yet
real, adverse impacts. These include the impacts on your company’s
standing in the capital markets and negative publicity – both of
which degrade the reputation, integrity and ethical standing of
life sciences organizations. Government agencies such as the
Department of Justice, Securities and Exchange Commission and FDA
are actively working to detect fraud within life sciences companies
and deliver lofty penalties to those involved. Implementation of
sufficiently robust fraud protection mechanisms is not just an
option but is imperative to the financial health and reputation of
your company. (Read
more...)
Protecting healthcare companies against fraud, reputation &
misconduct risk
APRIL 2007: At the end of the 20th
century and the beginning of the 21st century, several high profile
corporate fraud scandals jolted the financial markets and led to
decreased investor confidence. The scandals that rocked corporate
America over the past few years will have a lasting historical
impact.
Will historians dub these the frauds that changed America's
healthcare sector? Public outrage over corporate fraud has resulted
in new legislation, regulations and professional standards, which
focus on prevention and timely detection. For the first time,
corporate fraud is a key agenda item for boards of directors,
senior management, and independent auditors. (Read
more...)
2006
Feverish fraud
Knowledge is power for small
businesses finding a cure for the healthcare fraud epidemic.
MANY SMALL-BUSINESS OWNERS
ARE TRYING TO DO RIGHT BY THEIR employees by offering
health insurance. The trouble is, in recent years, smaller
companies have been faced with annual double-digit premium hikes,
which have left some entrepreneurs struggling to pay for a vital,
competitive employee benefit. (Read
more...)
2005
Fighting the Battle Against
Health Care Fraud
JUNE 2005: Health care fraud is a dangerous and
expensive crime. The national cost tops $85 billion a year and is a burden
borne by all of us…quot;employers, workers and tax payers…quot;in the form
of higher health insurance premiums, out-of-pocket costs and tax dollars.
Moreover, every dollar stolen by a con artist is a dollar not available for
emergency services, life-saving treatments, drugs, medical research and
other vital health care services. (Read
more...)
2001
Technology Curtails Health Care Fraud
APRIL 2001: Fraud in health care can assume diverse forms. According to the National
Health Care Anti-Fraud Association, the most common is billing for health
care services that were never rendered, either by adding charges to
legitimate claims, or by using actual patient names and health insurance
information to fabricate claims. Upcoding is the second most common; third
is the deliberate provision of medically unnecessary services, which include
tests, surgeries, and other procedures.
Other forms of provider fraud include waiving patient deductibles or
copayments, soliciting or receiving kickbacks for referrals, unbundling
charges, falsifying medical records, and fraudulent diagnosis or
misrepresentation of the diagnosis to justify payment. Medical-equipment
manufacturers have also gotten into the act. Some have been known to offer
"free" products to individuals and then charge insurers for products not
needed -- and, in some cases, never delivered. (Read
more...)
Prior 2000
Fraud in the health care
industry
JUNE 1996: The perpetrators of fraud don't
show favoritism. Although the following case studies examine three different
frauds related to health care, no industry is truly immune. (Read
more...)
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