Digital Commons Network^™

Health Insurance Fraud: An Overview, Sara J. Rosenbaum, Nancy Lopez, Scott Stifler

Health Policy and Management Faculty Publications

In 2007, the U.S. spent nearly $2.3 trillion on health care and public and private insurers processed more than 4 billion health insurance claims. The National Health Care Anti-Fraud Association (NHCAA) has estimated that, conservatively, 3% of all health care spending—or $68 billion—is lost to health care fraud. Other estimates by government and law enforcement agencies place fraud-related losses as high as 10% of annual health care spending; at this rate, the losses in 2007 alone – over $220 billion – would have been enough to cover the uninsured.

This report, funded by the Robert Wood Johnson Foundation, delves into …

The Impact Of Authentic Leadership And Ethical Organizational Culture On Auditor Behavior, Janice Taylor Morris Phd

Dissertations

Recently, unprofessional behavior resulted in several high-profile financial scandals and business failures. Many blamed external auditors of these companies' financial statements for failing to detect and/or report errors and fraud that led to the failures. Leaders within major audit firms have been urged to foster more ethical firm environments as a means of inhibiting dysfunctional auditor behavior (DAB) such as premature sign-off, gathering insufficient audit evidence, and the underreporting of time spent conducting an audit. This advice is based on two assumptions: (1) auditor behavior is one element of audit quality and (2) the behavior of employees is influenced by …

Defining A Forensic Audit, G. S. Smith, D. L. Crumbley

Journal of Digital Forensics, Security and Law

Disclosures about new financial frauds and scandals are continually appearing in the press. As a consequence, the accounting profession's traditional methods of monitoring corporate financial activities are under intense scrutiny. At the same time, there is recognition that principles-based GAAP from the International Accounting Standards Board will become the recognized standard in the U.S. The authors argue that these two factors will change the practices used to fight corporate malfeasance as investigators adapt the techniques of accounting into a forensic audit engagement model.

Qualitative Information In Annual Reports & The Detection Of Corporate Fraud : A Natural Language Processing Perspective, Sunita Goel

Legacy Theses & Dissertations (2009 - 2024)

High profile cases of fraudulent financial reporting such as those that occurred at Enron and WorldCom have shaken public confidence in the U.S. financial reporting process and have raised serious concerns about the roles of auditors, regulators, and analysts in financial reporting. In order to address these concerns and restore public confidence, the Sarbanes-Oxley Act (SOX) of 2002 was enacted. However, SOX has not lived up to its promise. Numerous cases of fraudulent financial reporting have surfaced in the post-SOX era. So far, the major thrust of research has been on examining fraud that has already been discovered. This dissertation …

Prevention Of Elder Mistreatment In Nursing Homes: Competencies For Direct-Care Staff, Dana Dehart, Jennifer Webb, Carol Cornman

Faculty and Staff Publications

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policymakers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with: definitions and policies; risks for mistreatment; communication and respect; and development of a cooperative working environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.

Self-Reported Cyber Crime: An Analysis On The Effects Of Anonymity And Pre-Employment Integrity, Ibrahim Baggili, Marcus Rogers

Electrical & Computer Engineering and Computer Science Faculty Publications

A key issue facing today’s society is the increase in cyber crimes. Cyber crimes pose threats to nations, organizations and individuals across the globe. Much of the research in cyber crime has risen from computer science-centric programs, and little experimental research has been performed on the psychology of cyber crime. This has caused a knowledge gap in the study of cyber crime. To this end, this research focuses on understanding psychological concepts related to cyber crime. Through an experimental design, participants were randomly assigned to three groups with varying degrees of anonymity. After each treatment, participants were asked to self-report …

Continuous Fraud Detection In Enterprise Systems Through Audit Trail Analysis, Peter J. Best, Pall Rikhardsson, Mark Toleman

Journal of Digital Forensics, Security and Law

Enterprise systems, real time recording and real time reporting pose new and significant challenges to the accounting and auditing professions. This includes developing methods and tools for continuous assurance and fraud detection. In this paper we propose a methodology for continuous fraud detection that exploits security audit logs, changes in master records and accounting audit trails in enterprise systems. The steps in this process are: (1) threat monitoringsurveillance of security audit logs for ‘red flags’, (2) automated extraction and analysis of data from audit trails, and (3) using forensic investigation techniques to determine whether a fraud has actually occurred. We …

Primetimes Newsletter, Winter 2008, Office Of Lifespan Studies

PrimeTimes Newsletter

PrimeTimes is the newsletter of the Office of Lifespan Studies in the College of Science at Coastal Carolina University.

Data Mining Techniques For Fraud Detection, Rekha Bhowmik

Annual ADFSL Conference on Digital Forensics, Security and Law

The paper presents application of data mining techniques to fraud analysis. We present some classification and prediction data mining techniques which we consider important to handle fraud detection. There exist a number of data mining algorithms and we present statistics-based algorithm, decision tree-based algorithm and rule-based algorithm. We present Bayesian classification model to detect fraud in automobile insurance. Naïve Bayesian visualization is selected to analyze and interpret the classifier predictions. We illustrate how ROC curves can be deployed for model assessment in order to provide a more intuitive analysis of the models.

Keywords: Data Mining, Decision Tree, Bayesian Network, ROC …

Lanthorn, Vol. 42, No. 52, March 24, 2008, Grand Valley State University

Volume 42, July 12, 2007 - June 12, 2008

Lanthorn is Grand Valley State's student newspaper, published from 1968 to the present.

An Unholy Alliance: Perceptions Of Influence In Insurance Fraud Prosecutions And The Need For Real Safeguards, Aviva Abramovsky

Journal of Criminal Law and Criminology

No abstract provided.

Data Mining Techniques In Fraud Detection, Rekha Bhowmik

Journal of Digital Forensics, Security and Law

The paper presents application of data mining techniques to fraud analysis. We present some classification and prediction data mining techniques which we consider important to handle fraud detection. There exist a number of data mining algorithms and we present statistics-based algorithm, decision treebased algorithm and rule-based algorithm. We present Bayesian classification model to detect fraud in automobile insurance. Naïve Bayesian visualization is selected to analyze and interpret the classifier predictions. We illustrate how ROC curves can be deployed for model assessment in order to provide a more intuitive analysis of the models.

Improving Corporate Governance : Character Education As A Supplement To Corporate Ethics Training, Richard L. Muney

Theses, Dissertations and Culminating Projects

This thesis explores the hypothesis that ethics training for corporate personnel will significantly increase ethical behavior and thereby significantly reduce the incidence of corporate malfeasance.

For over 100 years the federal government has been trying to curb malfeasance by managers of public corporations and their boards of directors. This thesis examines the history of that legislation and those regulatory efforts, concluding that these legislative and regulatory attempts have met with varying degrees of success, but, on balance, that success has been transitory at best. It also comes to the conclusion that corporate training programs in ethics, in the absence of …

Group Think: The Law Of Conspiracy And Collective Reason, Jens David Ohlin

Journal of Criminal Law and Criminology

No abstract provided.

The Cowl - V. 71 - N. 4 - Sept 21, 2006

The Cowl

The Cowl - student newspaper of Providence College. Volume 71 - Number 4 - September 21, 2006. 24 pages.

Paper Session Iv: Development And Delivery Of Coursework - The Legal/Regulatory/Policy Environment Of Cyberforensics, John W. Bagby, John C. Ruhnka

Annual ADFSL Conference on Digital Forensics, Security and Law

This paper describes a cyber-forensics course that integrates important public policy and legal issues as well as relevant forensic techniques. Cyber-forensics refers to the amalgam of multi-disciplinary activities involved in the identification, gathering, handling, custody, use and security of electronic files and records, involving expertise from the forensic domain, and which produces evidence useful in the proof of facts for both commercial and legal activities. The legal and regulatory environment in which electronic discovery takes place is of critical importance to cyber-forensics experts because the legal process imposes both constraints and opportunities for the effective use of evidence gathered through …

Implementation Of Sarbanes-Oxley: New Rules For Lawyers And What Lawyers Think, Olga Yevglevskaya-Wayne

ExpressO

This paper discusses practical implications of Sarbanes-Oxley for lawyers. Emphasis is on the new federal rules of professional responsibility the Act sets up. The paper includes the views of various renowned practitioners interpreting and using these rules. The paper also contains suggestions for how the Securities and Exchange Commission could potentially improve those areas that are proving problematic for attorneys so as to better effectuate the purpose of this major new law, in light of its legislative history and intent, which are also discussed in the paper.

A Patient-Centered Approach To Health Care Fraud Recovery, Joan H. Krause

Journal of Criminal Law and Criminology

No abstract provided.

The Decline Of The Attorney-Client Privilege In The Corporate Setting, William R. Mclucas, Howard M. Shapiro, Julie J. Song

Journal of Criminal Law and Criminology

No abstract provided.

Designing A Data Warehouse For Cyber Crimes, Il-Yeol Song, John D. Maguire, Ki Jung Lee, Namyoun Choi, Xiaohua Hu, Peter Chen

Journal of Digital Forensics, Security and Law

One of the greatest challenges facing modern society is the rising tide of cyber crimes. These crimes, since they rarely fit the model of conventional crimes, are difficult to investigate, hard to analyze, and difficult to prosecute. Collecting data in a unified framework is a mandatory step that will assist the investigator in sorting through the mountains of data. In this paper, we explore designing a dimensional model for a data warehouse that can be used in analyzing cyber crime data. We also present some interesting queries and the types of cyber crime analyses that can be performed based on …

A Curriculum For Teaching Information Technology Investigative Techniques For Auditors, Grover S. Kearns

Journal of Digital Forensics, Security and Law

Recent prosecutions of highly publicized white-collar crimes combined with public outrage have resulted in heightened regulation of financial reporting and greater emphasis on systems of internal control. Because both white-collar and cybercrimes are usually perpetrated through computers, internal and external auditors’ knowledge of information technology (IT) is now more vital than ever. However, preserving digital evidence and investigative techniques, which can be essential to fraud examinations, are not skills frequently taught in accounting programs and instruction in the use of computer assisted auditing tools and techniques – applications that might uncover fraudulent activity – is limited. Only a few university-level …

Development And Delivery Of Coursework: The Legal/Regulatory/Policy Environment Of Cyberforensics, John W. Bagby, John C. Ruhnka

Journal of Digital Forensics, Security and Law

This paper describes a cyber-forensics course that integrates important public policy and legal issues as well as relevant forensic techniques. Cyber-forensics refers to the amalgam of multi-disciplinary activities involved in the identification, gathering, handling, custody, use and security of electronic files and records, involving expertise from the forensic domain, and which produces evidence useful in the proof of facts for both commercial and legal activities. The legal and regulatory environment in which electronic discovery takes place is of critical importance to cyber-forensics experts because the legal process imposes both constraints and opportunities for the effective use of evidence gathered through …

Computer Forensics Field Triage Process Model, Marcus K. Rogers, James Goldman, Rick Mislan, Timothy Wedge, Steve Debrota

Journal of Digital Forensics, Security and Law

With the proliferation of digital based evidence, the need for the timely identification, analysis and interpretation of digital evidence is becoming more crucial. In many investigations critical information is required while at the scene or within a short period of time - measured in hours as opposed to days. The traditional cyber forensics approach of seizing a system(s)/media, transporting it to the lab, making a forensic image(s), and then searching the entire system for potential evidence, is no longer appropriate in some circumstances. In cases such as child abductions, pedophiles, missing or exploited persons, time is of the essence. In …

Detection Avoidance, Chris William Sanchirico

ExpressO

In practice, the problem of law enforcement is half a matter of what the government does to catch violators and half a matter of what violators do to avoid getting caught. In the theory of law enforcement, however, although the state’s efforts at "detection" play a decisive role, offenders’ efforts at "detection avoidance" are largely ignored. Always problematic, this imbalance has become critical in recent years as episodes of corporate misconduct spur new interest in punishing process crimes like obstruction of justice and perjury. This article adds detection avoidance to the existing theoretical frame with an eye toward informing the …

Price, Path & Pride: Third-Party Closing Opinion Practice Among U.S. Lawyers (A Preliminary Investigation), Jonathan C. Lipson

ExpressO

This article presents the first in-depth exploration of third-party closing opinions, a common but curious – and potentially troubling -- feature of U.S. business law practice. Third-party closing opinions are letters delivered at the closing of most large transactions by the attorney for one party (e.g., the borrower) to the other party (e.g., the lender) offering limited assurance that the transaction will have legal force and effect.

Hundreds, if not thousands, of legal opinions are delivered every week. Yet, lawyers often complain that they create needless risk and cost, and produce little benefit. Closing opinions thus pose a basic question: …

The Economic Effects Of Money Laundering On The Nigerian Economy: Some Emerging Issues., U. Kama

Economic and Financial Review

Although the economic effects of money laundering on economic development are difficult to quantify, it is evident that such activity damages the financial institutions which are critical to economic growth. Besides, it reduces productivity in the economy's real sector by diverting resources and encouraging crime and corruption, which slow economic growth. Furthermore, such activity can distort an economy's external sector through international trade and capital flows to the detriment of long-term economic development. This paper attempts to explore the economic effects of this malaise on the Nigerian economy. It observes that if money laundering is not tamed, it has the …

Central Florida Future, Vol. 37 No. 28, November 18, 2004

Central Florida Future

Golden Rule under review: Current rule could permit unfair expulsion; Hungry for change: Within a few feet from where senior Ben Mahon sits at a fancy table; being served a five-course meal junior Paigae Yim sits on the hard floor amongst bits of torn newspaper; Women studies art unite: LEAD Scholars group showcases work of local women artists; Get overseas credit on Spring Break: Study Abroad offers new programs in Africa and Japan.

Strict Liability For Gatekeepers: A Reply To Professor Coffee, Frank Partnoy

University of San Diego Law and Economics Research Paper Series

This article responds to a proposal by Professor John C. Coffee, Jr. for a modified form of strict liability for gatekeepers. Professor Coffee’s proposal would convert gatekeepers into insurers, but cap their insurance obligations based on a multiple of the highest annual revenues the gatekeepers recently had received from their wrongdoing clients. My proposal, advanced in 2001, would allow gatekeepers to contract for a percentage of issuer damages, after settlement or judgment, subject to a legislatively-imposed floor. This article compares the proposals and concludes that a contractual system based on a percentage of the issuer’s liability would be preferable to …

The Role Of The Central Bank In The Nigeria Financial System, Onyido C. Ben

Bullion

The central bank is pivotal in the management of the national economy. lts role is not only to regulate and monitor the financial system, but also to ensure its development, prevent financial distress which could undermine confidence in the system as well as facilitate sustained growth. This paper presents an overview of the Nigerian financial system, the functions of the Central Bank of Nigeria (CBN). It examines the Bank's monetary management, surveillance and promotional roles and the challenges for the CBN. The study concludes that, the enhanced operational autonomy of the CBN has provided a unique opportunity for the Bank …

Common Sense And Civic Virtue: Institutional Investors, Responsible Ownership, And The Democratic Ideal, Marcy Murninghan

New England Journal of Public Policy

On matters of governance, the people’s good is the highest law, as Cicero said two millennia ago. Unfortunately, these days personal greed has trumped the people’s good, enflaming the current governance crisis affecting our public, nonprofit, and private spheres. The spate of corporate governance scandals over the past several years jeopardizes equity investments, harms beneficiaries, and weakens global capital markets. The remedy is not just more laws and regulation but revitalization of the system of corporate checks and balances that already exists. To get better corporate governance, corporate shareowners, especially institutional investors, need to assert their rights and responsibilities more …