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What does a household insurance fraudster look like?

What does a household insurance fraudster look like? | Counter Fraud | Scoop.it

Research from the University of Portsmouth's Centre for Counter Fraud Studies analysed data (40k contents insurance claims from 2007 deemed fraudulent) from claims handler VFM Services, which revealed that the typical household fraudster will be a man aged 41-50 with no previous claims.

 

See additional information relating to the university's analysis here: http://www.insurancetimes.co.uk/Journals/2013/04/16/y/o/q/Graphs.jpg


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Motor insurance fraud up 10% since 2010

Motor insurance fraud up 10% since 2010 | Counter Fraud | Scoop.it

An insurance fraud investigation report revealed that personal injury claims are up 20% and fraudulent motor insurance claims are up c.10% over the past two years.

 

Fraud percentages (% as proportion of respondents in the report): 

- Motor fraud claims: up to 79% in 2012 from 72% in 2010

- Personal injury claims: up to 53% in 2012 from 42% in 2010

- 79% of investigators believe that aggregators and brokers need to do more to prevent fraud at policy inception (undertaking more stringent checks; undertaking identity checks; sharing more information)

 

The Insurance Fraud Bureau estimates that insurers invest >£200m per year in anti-fraud staff and systems. Such investment saved >£900m in claims payments in 2011.

 

Increasing numbers of counter-fraud professionals are now using geographic data as an added tool to discover fraudulent activity.


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Pharmaceutical scandal: The NHS, the drug firms and the price racket - Telegraph.co.uk

Pharmaceutical scandal: The NHS, the drug firms and the price racket - Telegraph.co.uk | Counter Fraud | Scoop.it
BBC News Pharmaceutical scandal: The NHS, the drug firms and the price racket Telegraph.co.uk Jim Gee, a former chief executive of the NHS counter-fraud service and now director of counter-fraud services at BDO, the accountancy network, said that...

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Paperless Treasury Management Helps Ensure Compliance

Paperless Treasury Management Helps Ensure Compliance | Counter Fraud | Scoop.it
Financial institutions face even heavier compliance duties to ensure all documents are accounted for and signed.
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Compliance Is Bad for Security | Optimal Security: The Lumension ...

Compliance Is Bad for Security | Optimal Security: The Lumension ... | Counter Fraud | Scoop.it
If you ask a compliance author, whether that's a government legislator or a bureaucratic regulator, what is the purpose of compliance, the reply will be 'to ensure security.' If you ask the same person, 'will I be compliant if I am ...
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Under the knife - 'for nothing' - Dailyrecord.com

Under the knife - 'for nothing' - Dailyrecord.com | Counter Fraud | Scoop.it
Under the knife - 'for nothing' Dailyrecord.com Lured by the millions of dollars that can be made by billing Medicare, Medicaid and private insurers for expensive procedures that aren't necessary, they're a top target of investigators who consider...
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Private healthcare fraud - a growing risk | Blog | False Economy

Private healthcare fraud - a growing risk | Blog | False Economy | Counter Fraud | Scoop.it
A new report from the Centre for Health & the Public Interest highlights how the increased use of private healthcare providers in the NHS opens up considerable opportunities for fraud.
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Compliance pressure builds - Financial News

Compliance pressure builds - Financial News | Counter Fraud | Scoop.it
Financial News Compliance pressure builds Financial News AIFMD scored an average rating of 1.55 out of three, followed jointly by the Foreign Account Tax Compliance Act, the fifth iteration of the Undertakings for Collective Investment in...
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Counter-terrorism tools used to spot staff fraud - FT.com - Financial Times

Counter-terrorism tools used to spot staff fraud - FT.com - Financial Times | Counter Fraud | Scoop.it
Counter-terrorism tools used to spot staff fraud - FT.comFinancial TimesJPMorgan Chase has turned to technology used for countering terrorism to spot fraud risk among its own employees and to tackle problems such as deciding how much to charge when...

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Justice Department Nabs Record $3 Billion From Health Care Fraud Settlements

Justice Department Nabs Record $3 Billion From Health Care Fraud Settlements | Counter Fraud | Scoop.it

According to Modern Healthcare, the Department of Justice took in $4.9 billion in collections and settlements through the False Claims Act in fiscal year 2012 — an all-time high, largely bolstered by over $3 billion in collections from health care firms.
The False Claims Act encourages whistleblowers to report fraudulent activities undertaken by private actors against the U.S. government. This past fiscal year, the Justice Department received its highest-ever haul from health care firms engaging in Medicare fraud and pharmaceutical companies promoting drugs for off-label use not authorized by the FDA:
Top among the healthcare settlements in 2012 was GSK’s agreement to pay $1.5 billion in civil remedies to resolve charges, without admitting liability, in allegations that it promoted Paxil, Wellbutrin, Advair, Lamictal and Zofran for off-label uses, as well as making false statements about the safety of Avandia and paying kickbacks to doctors to prescribe Imitrex, Lotronex, Flovent and Valtrex.
GSK’s civil payments were part of a $3 billion “global” settlement with federal and state governments that also included criminal fines and pleas and an unusual corporate integrity agreement that changed how the company compensates sales staff and executives.
Also in 2012, the Justice Department reported collecting $441 million to resolve allegations that Merck illegally marketed the painkiller Vioxx, which was pulled from the market in 2004. That settlement, which came without an admission of wrong-doing, was part of a $950 million resolution that involved criminal and civil fines and settlements.
Fraud in government health care programs has been a consistent target of the Obama Administration in an effort to protect consumers and lower wasteful health spending. Doctors regularly overbill Medicare through shoddy, fraudulent procedures such as “self-referring” their patients and “upcoding” the complexity of the services they provide patients in order to reap undeserved profits.
But the biggest settlements from the past fiscal year’s False Claims Act collections stem from pharmaceutical companies engaging in unlawful and misleading drug promotions — a practice that was upheld by a federal appellate court on Monday and may soon head to the Supreme Court.


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Biometric Technology Combats Medical Identity Theft

Biometric Technology Combats Medical Identity Theft | Counter Fraud | Scoop.it
Such fraud costs health-care providers billions annually. Demand is growing for biometric devices such as iris scanners
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Microsoft's cloud licensing sets up a compliance nightmare - InfoWorld (blog)

Microsoft's cloud licensing sets up a compliance nightmare - InfoWorld (blog) | Counter Fraud | Scoop.it
Microsoft's cloud licensing sets up a compliance nightmare
InfoWorld (blog)
On the list of things that IT pros would rather never have to think about, software licensing takes a close second behind backups.
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Fraud, Bribery and Corruption Survey

Fraud, Bribery and Corruption Survey | Counter Fraud | Scoop.it
For almost two decades, KPMG has been undertaking research in the growth and extent of fraud in corporate Australia and New Zealand. Over that time fraud has continued to rise, despite enhanced risk mitigation procedures.  

Our biennial survey offers a unique window into an often opaque world. Given the high cost of fraud to public and private sector organisations in Australia and New Zealand, it is imperative to bring some clarity to a problem that tends to flourish in business cultures where transparency is poor.


In profiling the victims, villains and heroes of fraud, the report provides Australian and New Zealand-based businesses with an opportunity to understand not only the impact of fraud, but how it takes root in organisations that are not prepared to battle it.


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The Learning Factor's curator insight, June 11, 2013 7:10 PM

KPMG's survey has found that $373 million was stolen over the past two years and the average value of fraud loss is now more than $3 million.

John Miller's curator insight, June 24, 2013 11:49 PM

Interesting to note that in New Zealand and Australia they are having open and public debate over immigration, outsourcing jobs to China, and so on.  It would seem natural that Canada should do the same.  Unless of course the fraud, bribery and corruption have already done their work!

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How social network analytics can combat fraud | Government Health IT

How social network analytics can combat fraud | Government Health IT | Counter Fraud | Scoop.it
Government health care fraud is big business.

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Private healthcare fraud - a growing risk - Open Democracy

Private healthcare fraud - a growing risk - Open Democracy | Counter Fraud | Scoop.it
Private healthcare fraud - a growing risk
Open Democracy
The main body countering NHS fraud is NHS Protect, which has a counter fraud service within it.
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Why fraud follows government contracting - Washington Post

Why fraud follows government contracting
Washington Post
The Post's June 15 Metro article “Va.
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Doctors Perform Thousands of Unnecessary Surgeries - 13WMAZ

Doctors Perform Thousands of Unnecessary Surgeries - 13WMAZ | Counter Fraud | Scoop.it
Doctors Perform Thousands of Unnecessary Surgeries 13WMAZ Lured by the millions of dollars that can be made by billing Medicare, Medicaid and private insurers for expensive procedures that aren't necessary, they've become a top target of...
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Event Registration (EVENT: 623983 - SESSION: 1)

Kaspersky Lab will host a special webinar on Compliance for Businesses on Wed, June 26 12pm EDT. Register here: http://t.co/FIWovbQMe8
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Oct 17: Financial Crime & Compliance Seminar - Bernews

Oct 17: Financial Crime & Compliance Seminar Bernews yCompliance, KPMG in Bermuda and the Association of Certified Anti-Money Laundering Specialists [ACAMS] present the inaugural Financial Crime & Compliance Seminar at the Fairmont Southampton in...
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Groupama bolsters Counter Fraud team - Insurance Daily

Groupama bolsters Counter Fraud team - Insurance Daily | Counter Fraud | Scoop.it
Groupama bolsters Counter Fraud team
Insurance Daily
Groupama Insurances has announced the hiring of Marc Yeates, the counter fraud expert, to occupy the role of Counter Fraud Claims adviser.
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Health System Waste Tallied - Report and Infographic from Institute of Medicine

Health System Waste Tallied - Report and Infographic from Institute of Medicine | Counter Fraud | Scoop.it

Infographic has harsh data on use of information technology, making healthcare safer & more transparent and collaborative between providers and patients.

=================

Summary from NY Times: The health care system squanders $750 billion a year, 30 cents of every medical dollar, through unneeded care, byzantine paperwork, fraud and other waste.  Controlling health care costs is one of the keys to reducing the deficit. The report came from an 18-member panel of experts, including doctors, business people and public officials.


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A Costly Equation: Medical Dollars Wasted Are Greater Than the U.S. Defense Budget

A Costly Equation: Medical Dollars Wasted Are Greater Than the U.S. Defense Budget | Counter Fraud | Scoop.it

by MARSHALL ALLEN, ProPublica

 

I’ve heard a lot of reports about the staggering amount of fraud, overtreatment and unnecessary health care in the United States. But the recent “Best Care at Lower Cost” report by the Institute of Medicine included this stunner: In 2009, the health care system wasted an estimated $765 billion– more than the entire budget of the Department of Defense.

I’ve got to hand it to the IOM committee for finding an interesting way to give those numbers a punch.
 

The report outlined the varieties of waste: Care is provided that’s not based on evidence; discretionary care is used too much; high cost options are chosen rather than avoided; care is fragmented; insurance administration and paperwork are inefficient; and fraud is at every level. The estimates of money poorly spent included:
 

$210 billion on overuse and unnecessary care.$130 billion in inefficiency, including mistakes and harm.$190 billion in excess administrative costs. [MORE]
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CRIF : counter fraud intelligence in one click - News-Insurances (press release)

CRIF : counter fraud intelligence in one click - News-Insurances (press release) | Counter Fraud | Scoop.it
CRIF : counter fraud intelligence in one click News-Insurances (press release) Designed to deliver counter fraud intelligence to investigators in one click, Sherlock can be utilised whenever fraud is suspected.  An easy to use, web based...
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Organization fights against health care fraud - Palm Coast Observer

Organization fights against health care fraud - Palm Coast Observer | Counter Fraud | Scoop.it
Palm Coast Observer
Organization fights against health care fraud
Palm Coast Observer
Each year, an estimated $68 billion is lost to Medicare fraud, according to the National Health Care Anti-Fraud Association.
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