The fraud occurs on both ends from the insurer, to the people who use insurance including the physicians and the patients. A frauds usually cost Americans about thirty billion each year, which is a high cost for the amount of the money that those involved in the fraud often get from insurance O'Rourke, For example, In alone one trillion were spent on health care, and percent of that payment was comprised of health insurance fraud Skeen, Research Papers words 4.
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Martin Frankel owned several mansions, luxury cars, and diamonds. He lived a life of complete luxury. A life of luxury that was paid for with money stolen through insurance fraud. Martin Frankel is one of the major contributors to insurance fraud. He constructed a scheme to embezzle over million dollars from insurance companies in several states across the U.
He began his first minor case of insurance fraud in and was not convicted until for insurance fraud, racketeering, and money laundering Free Essays words 1. Fire Administration, Also called economic arson, arson for profit occurs when businesses or individuals deliberately set fires in order to dispose of insured property, including buildings, automobiles, boats, and land, and reap financial benefits by filing insurance claims against the property U.
Arson for profit is a serious crime, resulting in destroyed property, higher insurance premiums, wasted government resources, and even death Goetz, ; U. Verma and Mani highlighted that the increasing number of mobile devices and social media platforms are bringing significant transformations in the world of business including the insurance sector. The opportunities offered by this landscape for insurers are vast Research Papers words 3.
Private plans must include at least all services offered in Parts A and B, and may include reduced cost sharing or premiums.
Administrative costs for Part C totaled 1. Beneficiary payments vary by plan, and are based on capitation; beneficiaries pay a fixed monthly amount regardless of the actual services used Klees et al.
insurance fraud essays
The essay-for-hire industry has expanded significantly in developing countries with many English speakers, fast internet connections and more college graduates than jobs, especially Kenya, India and Ukraine. A Facebook group for academic writers in Kenya has over 50, members. After a month of training, Ms. The New York Times is identifying Ms. Mbugua by only part of her name because she feared that the attention would prevent her from getting future work.
A study of students in North America found that 7 percent of undergraduates admitted to turning in papers written by someone else, while 3 percent admitted to obtaining essays from essay mills. Cath Ellis, a leading researcher on the topic, said millions of essays are ordered online every year worldwide. When such websites first emerged over a decade ago, they featured veiled references to tutoring and editing services, said Dr. Bertram Gallant, who also is a board member of the International Center for Academic Integrity, which has worked to highlight the danger of contract cheating.
Now the sites are blatant. A representative for UvoCorp, another of the companies, said its services were not meant to encourage cheating. Representatives for Academized and Ace-MyHomework did not return emails and phone calls seeking comment. A major scandal involving contract cheating in Australia caused university officials there to try to crack down on the practice.
A similar effort to confront the industry has emerged in Britain, but not in the United States. Contract cheating is illegal in 17 states, but punishment tends to be light and enforcement rare. Experts said that no federal law in the United States, or in Kenya, forbids the purchase or sale of academic papers, although questions remain about whether the industry complies with tax laws. Loller said he had worked with some colleges that have students who have never shown up for class or completed a single assignment. Contract cheating is harder to detect than plagiarism because ghostwritten essays will not be flagged when compared with a database of previously submitted essays; they are generally original works — simply written by the wrong person.
Some of the websites operate like eBay, with buyers and sellers bidding on specific assignments.
Insurance Fraud Cover Letter
Others operate like Uber, pairing desperate students with available writers. Either way, the identities and locations of both the writers and the students are masked from view, as are the colleges the assignments are for. Still, in some of the assignments that Ms. There is a general presumption that some form of intention or knowledge mens rea is necessary for the commission of a criminal offence because of the impact of criminal penalties including loss of liberty. Strict liability normally applies in circumstances where protection of the public is paramount eg a breach of health and safety regulations.
The authors propose that a new strict liability criminal offence is enacted specifically addressing the supply of academic essays to avoid the need for a prosecutor to establish intention or knowledge as a prerequisite to criminal liability. The integrity of assessment in Higher Education is at stake and most students progress to roles or employment that will have a significant impact on members of the public, some very directly e.
An example of an offence of strict liability might be adapted from existing US Legislation Newton and Lang :. Offences of strict liability promote high standards of care, provide a strong deterrent, make enforcement easier and usually operate in relation to businesses in which the penalty is a fine so that individual liberty is not at stake. However the penalty should be substantial to avoid companies simply viewing a fine as an expense of the business or a nominal tax on illegal enterprise. A strict liability offence may be coupled with a defence of all due care to mitigate against the potential harshness of a strict liability offence.
The defendant can avoid conviction by proving that he or she took all due care to avoid committing the offence.
Essay about The Problem of Insurance Fraud
Other jurisdictions have enacted specific offences addressing the mischief of essay writing services. Most require some form of intention or knowledge on the part of the offender and this leads to difficulty in establishing liability based on available evidence. However this could easily be incorporated into the proposal above by adding a caveat, as shown below with modifications in italics. Internationally there have been efforts to pursue contract cheating through legal means and these were described in detail in a recent chapter of the Handbook of Academic Integrity Newton and Lang To summarise here, there are specific laws preventing contract cheating in 17 states of the USA, but these laws date back to the s and have rarely been used successfully.
Again, this law does not appear to have been commonly used. Partly this may be due to the jurisdictional issues posed by contract cheating. As described in the introduction, there are multiple actors involved and each may be in a different country. Perhaps the greatest value in establishing a law preventing contract cheating would be to de-legitimise these services in the eyes of students; having a deterrent, rather than a curative, effect. Despite our conclusion that the current activities of UK-based essay writing companies do not appear to violate the terms of the Fraud Act, we have identified other possible legal approaches to addressing contract cheating via a legal means.
The first is in the apparent discrepancy between the terms and conditions used by the companies, which frequently urges caution in the use of purchased assignments for misconduct, and their advertising which can actively encourage it. Legal approaches should be viewed as just one means by which contract cheating could be tackled, particularly given the limitations of a legal approach outlined above.
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Other strategies could include the increased use of assessment modalities which are not so easily purchased, such as face-to-face presentations and practical skills assessments reviewed in Newton and Lang Additional approaches would also benefit from support through regulation, such as a requirement from accrediting organisations to include a minimum proportion of face-to-face assessment.
In summary then, the current status of the UK Fraud Act does not lend itself to successful legal pursuit of essay writing companies in the UK. However this could be addressed with a modification to the Act. The principles identified could be adopted in other countries. Read with section 34 1 of that Act and section 4 1 of the Theft Act Northern Ireland read with section 32 1 of that Act.
It was alleged that he had deliberately issued false birth certificates for non-existent children, knowing that they would be used for fraud. Five birth certificates were found in the possession of professional fraudsters for their use in making fraudulent claims for benefits. R v Registrar of companies, ex parte A-G  BCLC — attempted registration of a company to carry on the business of prostitution. In: BBC News. Accessed 1 June Consumer attention to standard form contracts.
Camb Law J — Lancaster T, Clarke R Contract cheating: the outsourcing of assessed student work. In: Bretag T ed Handbook of academic integrity. Springer, Singapore, pp — Morris EJ Academic integrity: a teaching and learning approach.
In: Bretag TA ed Handbook of academic integrity. Springer, Singapore, pp 1— Newton P Academic integrity: a quantitative study of confidence and understanding in students at the start of their higher education. Assess Eval High Educ — Saunders J Plagiarism and the law. Learn Publ — Sivasubramaniam S, Kostelidou K, Ramachandran S A close encounter with ghost-writers: an initial exploration study on background, strategies and attitudes of independent essay providers. Int J Educ Integr.
Springer, Singapore, pp 39— Accessed 10 Sept Educ Stud — Download references. The authors would like to thank Dr Patrick Bishop of the College of Law and Criminology for reviewing the manuscript prior to submission. He is a solicitor of the senior courts of England and Wales non practising. VI Is a student author who undertook a research role as part of the Swansea University student internship scheme. He identified the sites and their common practises. He also wrote the manuscript with MD.
Outlier based predictors for health insurance fraud detection within U.S. medicaid
All authors read and approved the final manuscript. Correspondence to Philip M. Reprints and Permissions. Search all BMC articles Search. Identification of companies As part of a separate project we identified approximately distinct websites offering essay-writing or related services to students in Higher Education.
Results Shown below are questions that we asked of the websites. The Fraud Act The Act UK Government provides for a general offence of fraud, defined through the three ways of committing it, which are 1 by false representation, 2 by failing to disclose information and 3 by abuse of position.
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