According to Mitchell and Scott, authors of "America's Problems and Needed Reforms," quandary ethics concern tangible and concrete moral dilemmas. Business schools, they state, often teach ethical and moral issues as problems to be solved. They believe that when organizational rules are applied in solving quandary problems they are seldom sufficient, because they do little to enhance moral character.
According to the Coalition Against Insurance Fraudthe causes vary, but are usually centered on greed, and on holes in the protections against fraud.
Compared to those for other crimes, court sentences for insurance fraud can be lenient, reducing the risk of extended punishment. Though insurers try to fight fraud, some will pay suspicious claims anyway; settling such claims is often cheaper than legal action.
Another reason for fraud is over-insurance, when the amount insured is greater than the actual value of the property insured. The most common forms of insurance fraud are reframing a non-insured damage in order to make it an event covered by insurance and inflating the value of the loss.
Losses due to insurance fraud[ edit ] It is hard to place an exact value on the money stolen through insurance fraud. Insurance fraud is deliberately undetectable, unlike visible crimes such as robbery or murder.
As such, the number of cases of insurance fraud that are detected is much lower than the number of acts that are actually committed. Criminal rings are sometimes involved in hard fraud schemes that can steal millions of dollars.
For example, when involved in an automotive collision an insured person might claim more damage than actually occurred. Soft fraud can also occur when, while obtaining a new health insurance policyan individual misreports previous or existing conditions in order to obtain a lower premium on his or her insurance policy.
Murderers for life insurance money Life insurance fraud may involve faking death to claim life insurance. Fraudsters may sometimes turn up a few years after disappearing, claiming a loss of memory.
Darwin was reported as "missing" after failing to report to work following a canoeing trip on March 21, He reappeared on December 1,claiming to have no memory of the past five years.
Another example is former British Government minister John Stonehouse who went missing in from a beach in Miami. He was discovered living under an assumed name in Australiaextradited to Britain and jailed for seven years for fraud, theft and forgery.
Health care insurance[ edit ] See also: Medicare fraud and Health care fraud Health insurance fraud is described as an intentional act of deceiving, concealing, or misrepresenting information that results in health care benefits being paid to an individual or group. Fraud can be committed either by an insured person or by a provider.
Provider fraud consists of claims submitted by bogus physicians, billing for services not rendered, billing for higher level of services, diagnosis or treatments that are outside the scope of practice, alterations on claims submissions, and providing services while medical licenses are either suspended or revoked.
Independent medical examinations debunk false insurance claims and allow the insurance company or claimant to seek a non-partial medical view for injury-related cases.
According to the Coalition Against Insurance Fraudhealth insurance fraud depletes taxpayer-funded programs like Medicare, and may victimize patients in the hands of certain doctors.
Many physicians see it as necessary to provide quality care for their patients.
Many patients, although disapproving of the idea of fraud, are sometimes more willing to accept it when it affects their own medical care. Program administrators are often lenient on the issue of insurance fraud, as they want to maximize the services of their providers.
To do this, physicians often bill for a different service, which is covered by the policy, rather than that which they rendered.Evaluate real case studies that demonstrate these fraud schemes; Distinguish the 5 fraud indicators and 5 fraud preventive measures for each fraud scheme CPE: Level: Intermediate From there McKenzie joined SAS and was the fraud lead for Canada.
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