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SAS 99 defines fraud as an intentional act that results in a material misstatement in financial statements. There are two types of fraud considered: misstatements arising from fraudulent financial reporting (e.g. falsification of accounting records) and misstatements arising from misappropriation of assets (e.g. theft of assets or fraudulent expenditures).
A "representation" is a pre-contractual statement made during negotiations. [4] If a representation has been incorporated into the contract as a term, [5] then the normal remedies for breach of contract apply. Factors that determine whether or not a representation has become a term include: The relative expertise of the parties. [6] [7]
The Anti-Kickback Statute [1] (AKS) is an American federal law prohibiting financial payments or incentives for referring patients or generating federal healthcare business. . The law, codified at 42 U.S. Code § 1320a–7b(b), [2] imposes criminal and, particularly in association with the federal False Claims Act, civil liability on those who knowingly and willfully offer, solicit, receive ...
Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare (United States) or equivalent State programs. The manner in which this is done varies, and persons engaging ...
Pharmaceutical fraud is when pharmaceutical companies engage in illegal, fraudulent activities to the detriment of patients and/or insurers. Examples include counterfeit drugs that do not contain the active ingredient, false claims in packaging and marketing, suppression of negative information regarding the efficacy or safety of the drug, and violating pricing regulations.
Jimmy Carter signs Medicare-Medicaid Anti-Fraud and Abuse Amendments into law. The Office of Inspector General for the U.S. Department of Health and Human Services, as mandated by Public Law 95-452 (as amended), is established to protect the integrity of Department of Health and Human Services (HHS) programs, to include Medicare and Medicaid programs, as well as the health and welfare of the ...
(Reuters) - Electronic health records vendor NextGen Healthcare Inc has agreed to pay $31 million to resolve allegations that the company violated the False Claims Act, the U.S. Justice Department ...
Cifas is a British fraud prevention service, a not-for-profit membership organization for all sectors that enables organizations to share and access fraud data using their databases. Cifas is dedicated to the prevention of fraud, including internal fraud by staff, and the identification of financial and related crime.