Will Digital Payments Help Reduce Healthcare Fraud?

A timely article in the Guardian discusses a trend toward mobile payments and how it is changing the healthcare industry. Most notable for fraud fighters is what this new development could mean for protecting consumers. At its essence, digital currency helps to simplify the payment process and thus provides fewer opportunities for malfeasance. As the article states:

“...it is becoming increasingly apparent that digital payments in rural, remote areas settings are quicker, easier, and safer. The likelihood of fraud drops as fewer hands are needed to transfer the money. And the transaction costs decline, making it cheaper for providers to reach rural populations.”

The article provides accounts of three different locations where digital payments are making a difference in the delivery and availability of healthcare: Tanzania, Zanzibar and Pakistan. Obviously, the message is that this is positioned to become a worldwide trend. Fraud risk experts have to be hopeful on that point, as healthcare fraud is currently still a massive source of loss and damage to the economy.

No single governmental body collects and compiles information on healthcare fraud. But based on the numbers we do know, the scale of it is staggering. In the U.S., for example, the Justice Department secured $3. 8 billion in settlements and judgments from civil cases involving fraud against the government in the fiscal year ending Sept. 30, 2013. Knowing that mot fraud still goes undetected, one can only guess at the total losses suffered not only in the West, but also in developing countries where controls are few and far between.

Healthcare fraud is a scourge not only because of its criminal nature. It also raises costs and impacts patients, providers and insurance carriers significantly. Awareness of this type of fraud is crucial, as it often involves collusion between multiple parties and can be more difficult to detect than other types of fraud.

As the Guardian reported, digital payment systems that are properly developed can help limit this type of fraud, at least at that part of the process. Any relief is welcome. However, it will be imperative that anti-fraud experts are consulted and assist with the implementation of such systems. Otherwise, they can carry their own fraud risk, as is the case with any digital system. Hacking, data breaches and other common methods of fraud will target such systems and security personnel will need to be trained and on guard to stop them.

Without a serious focus on isolating and reducing healthcare fraud globally, the problem will continue to spiral out of control.

CRI Group Once Again Joins Movement to Shine Spotlight on Fraud

International Fraud Awareness Week kicks off Nov. 16, 2014 worldwide

Fraud costs organizations worldwide an estimated 5 percent of their annual revenues, according to a study conducted by the Association of Certified Fraud Examiners (ACFE). If applied to the 2013 estimated Gross World Product, this translates to a potential projected global fraud loss of nearly $3.7 trillion.

The seriousness of the global fraud problem is why CRI Group will be once again participating in International Fraud Awareness Week, Nov. 16-22, 2014, as an official supporter to promote anti-fraud awareness and education. The movement, known commonly as Fraud Week, champions the need to proactively fight fraud and help safeguard business and investments from the growing fraud problem.

CRI Group joins hundreds of organizations who have partnered with the ACFE, the world's largest anti-fraud organization and premier provider of anti-fraud training and education, for the yearly Fraud Week campaign.

As a global supplier of risk management, forensic accounting, due diligence and background screening services for some of the world’s leading business organizations, CRI Group is uniquely positioned help raise awareness of fraud and push the goal of Fraud Week forward. 

At a time when fraud is greatly affecting businesses and hurting their bottom line, CRI Group excels at deterring, detecting and investigating such crimes. A business intelligence network in over 80 countries allows us to get local knowledge in places our competitors cannot.

We achieve success using a global network of professionals specially trained in investigative due diligence, financial crime investigations, counter fraud and counter corruption solutions and third-party risk management.

For more information about increasing awareness and reducing the risk of fraud during International Fraud Awareness Week, visit FraudWeek.com.

The 2014 Report to the Nations is available for download online at the ACFE’s website: ACFE.com/RTTN. The Report is in PDF format.

Leading by Example: Fighting Fraud From the Top

“You shouldn’t blindly accept a leader’s advice. You’ve got to question leaders on occasion.”     – Sir Richard Branson, CEO of Virgin Group

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Leaders – in business, politics and life – are not chosen at random. They move to the fore through traits of personality and character. Often strong-willed and charismatic, they influence people and gain followers through their deeds and their words.

It is the faith that many of us put in our leaders that makes it all the more difficult to accept that they are fallible. Sometimes, the same instincts and attitudes that pushed a leader to the top can end up being a weakness if they cause the person to tune out doubts, or questions… or criticisms. In the business world, this can lead to disaster.

The Enron fraud more than 10 years ago taught us what can happen when “the smartest people in the room” begin to make flawed decisions. In the end, the massive accounting fraud went straight to the top, leading to criminal and civil charges for top company executives. They had allowed a culture of unethical behavior to run amok, and it led to the company’s undoing.

Fraud and corruption affect organisations worldwide, and no region or industry is immune. Transparency International (TI) provides exhaustive research on this problem in its yearly Corruption Perceptions Index. According to TI, the Index “serves as a reminder that the abuse of power, secret dealings and bribery continue to ravage societies around the world. The Index scores 177 countries and territories on a scale from 0 (highly corrupt) to 100 (very clean). No country has a perfect score, and two-thirds of countries score below 50. This indicates a serious, worldwide corruption problem.”

The findings are backed up by a recent PwC survey that finds economic crime is rising globally. The survey was completed by 5,128 respondents from 95 countries between August and October 2013, and of the respondents, 50 per cent were senior executives, 35 per cent represented publicly listed companies, and 54 per cent were from organizations with more than 1,000 employees.

Some 37 per cent of respondents, a 3 per cent rise since 2011, say they have been victims of economic crime, according to the survey. And, about 25 per cent say they have been victims of cybercrime, as fraudsters increasingly turn to technology as their main crime tool.

In a news release, Steven Skalak, PwC Forensic Services partner and lead editor of the survey, said: “Like a stubborn virus, economic crime persists despite ongoing efforts to combat it. No organisation of any size anywhere in the world is immune to the impact of fraud and other crimes.”

What does this say about leadership? Sadly, it tells us that it is failing, at least when it comes to stemming fraud and corruption. This stark reality makes fraud prevention and proper due diligence an absolute must for any organisation.

Preventing fraud is a proactive endeavor. Unfortunately, discovering it after it already exists is usually too late to save a company from losses. The greatest visionaries will look beyond their “instincts” and “gut feelings,” which have no doubt served them well, but might cloud problems that lurk in the details.

Leaders in business must be open to changing the culture of their organisation and listening to those who might question, or even criticize, business practices that could lead to fraud. The most effective leaders will engage their employees and seek out experts, as needed, to strengthen the company and help protect it from unseen risks What kind of leader are you? What kind of leader do you want to be?


New EY Survey Shows Troubling Fraud, Corruption Trends

New findings published by Big Four accounting firm EY (formerly Ernst & Young) in its 13th Global Fraud Survey show concerning levels of perceived fraud, bribery and corruption across the world. According to EY, the survey included in-depth interviews with more than 2,700 executives across 59 countries, including chief financial officers, chief compliance officers, general counsel and heads of internal audit. Nearly 40% of all respondents believe that bribery and corruption are widespread in their country.

Perhaps even more alarming than that, however, is the apparent disconnect the study shows among the business leaders who were surveyed. Even with the consensus that threats such as cybercrime are increasing, nearly half (48 percent) of them “considered it to represent a very or fairly low risk to their business.”

That's not a huge surprise to those of us working in the anti-fraud field. Fraud is always considered “somebody else's problem” and “it couldn't happen here” for many business leaders around the world. When it does occur, companies often find that the controls they had in place, if any, were exceedingly inadequate or ineffective in stemming the damage caused by fraud.

According to EY's press release, “the survey also found that compliance fatigue within businesses appears to have set in at a time when they can least afford it. In a regulatory environment in which international cooperation is becoming more frequent, our respondents described a largely static internal compliance environment,” as detailed here:

  • One in five businesses still do not have an ABAC policy

  • 45% of organizations have not introduced a whistleblowing hotline

  • Less than 50% of respondents have attended ABAC training

  • Less than a third of businesses are conducting anti-corruption due diligence as part of their mergers and acquisitions process.

The corruption trends are increasingly worrisome. According to the report, the executives themselves are being confronted with corruption issues, even on a personal basis: “Twenty-one percent of CEOs said that they had been approached to pay a bribe in the past, compared with 10% of all C-suite interviewees... Worryingly, given their role in setting an ethical tone from the top, a significant minority (11%) of CEOs considered misstating financial performance to be justifiable in order to help a business survive an economic downturn, compared with 6% of all respondents.”

Let that sink in for a moment. The business leaders we are trusting to set the tone and enforce an ethical workplace among their employees, contractors and business partners are themselves being tempted to engage in fraud.

The entire report is worth reading, and it's important to reflect on the results. Only by making a concerted effort to keep fraud and corruption at bay – through proactive controls, prevention and detection – will these trends be reversed. It's a global battle, and every business leader needs to be on the right side, partnering with experts who can help them protect their company and their investments.

CRI Group Named Finalists in 'Best Ad Awards' - Cast Your Vote Today

We are proud to announce that CRI Group's "You secure their future... We'll secure their past" advertisement has been named one of the finalists for "Most Effective Message" and "Best Headline" in a prestigious award competition hosted by PreemploymentDirectory.com. Voting commenced June 11th 2014 for the selection of the winners in the Best Ads Awards competition in the Background Screening Industry.

The "Most Effective Message" award is for the advert that "will most likely produce the intended or expected result it was designed to produce and/or will stimulate readers to take a desired action." The "Best Headline" category recognizes "the headline that grabs your attention the most and which you found to be most compelling."  CRI Group's advert notes that:

"Global hiring is on the rise. Are you confident your candidates truly have the skills, credentials, knowledge and experience they claim on their résumé, or during an interview? How can you be certain of the integrity, background and personal history of potential hires? CRI Group can help."

The ad helps communicate what CRI Group offers clients and partners: user-friendly, web-based background screening services with flexible, bespoke employment solutions for a range of various industry sectors with clients utilising this service across the globe. Our latest online portal is the industry’s most highly developed and internationally customized software platform – providing the CRI Group Background Screening Division an enterprise-level solution.

Winners will be announced in July and voters can be entered for the chance to win a gift. To vote, follow the link - http://preemploymentdirectory.com/2013-best-advertisers-of-the-year-awards-voting-process/#axzz34JPcZpX4.

Celebrate! CRI Group Looks Back at 24 Years

In 1990, Mikhail Gorbachev was premier of the Soviet Union. Great Britain was seized by a record heat wave. The Space Shuttle Discovery placed the Hubble Telescope in orbit. And CRI Group was born, destined to become a leading due diligence firm serving clients around the world.

We are celebrating a special milestone at CRI Group as it's our 24th anniversary, and we want to thank our clients and all of our staff for making this occasion a reality. As we enter our 25th year, we hold steadfast to our commitment to integrity and remaining faithful to our customers' trust.

A lot has changed in the past 24 years in the realm of due diligence and risk management. Fraud and corruption, once kept behind closed doors or “swept under the rug” as a part of business, are now in the public eye and under scrutiny. New laws and regulations like the UK Bribery Act are in effect, promising steep penalties for companies that don't conduct proper due diligence and run afoul of the law.

In any business, longevity is a sign of success... and this is a proud milestone for us. Our services have been based upon being innovative in the world of due diligence, risk management and investigation – while always staying focused on the needs of our clients.

Thank you for taking this voyage with us. We look forward to the years ahead, always looking for new technology, best practices and different and effective ways to examine data and events.