Risk

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While you're enjoying lunch, are employees risking your reputation at theirs?

Corporate risk

What are your employees really doing?

Impact

The ACFE reported in 2016 over 83.5% of occupational fraud was related to assets misappropriation. Of the 83.5 % AM cases, expense fraud accounted for 14% with a median loss of $40,000.

Detection Methods

Detection methods relied heavily on costly or luck discovery systems. The top 3 detection methods were 1. Tip (39%) 2. Internal audit (16.5%) 3. Management review (13.4%).

 

Concealment

Expense fraud has a long life span due to ease of concealment. Concealment methods 1. Create fraudulent document (52.9%) 2. Alter physical document (52.9%) 3. Alter transactions (42.2%).

 

 

Healthcare Provider Risk

What are vendors reporting about you?

Sunshine Act

Since Aug. 1, 2013, the Physician Payments Sunshine Act (Sunshine Act), requires manufacturers of drugs, medical devices, and laboratories, that participate in U.S. federal healthcare programs, to track and then report certain payments and items of value given to physicians and teaching hospitals.

Sunshine Mission

The mission or intent behind the Sunshine Act was to make transfer of value relationships between healthcare providers and medical product vendors transparent to the public. This could empower patients to make appropriate decisions on who's delivering their medical treatment. Open Payment data is available at cms.gov/openpayments.

Whats on the line?

In short...ALOT! Physicians are at risk of fraudulent reporting because most companies have no way to prove that what their employees are expensing are bonafide. Example: A representative takes his family out for dinner and writes it up under a physician for expense purposes. How will anyone know if it was a dinner with the doctor or not?

You can protect your reputation at no cost!

American Medical Association - Manufacturers will submit the reports to the Centers for Medicare & Medicaid Services (CMS) on an annual basis. In addition, manufacturers and group purchasing organizations must report certain ownership interests held by physicians and their immediate family members. CMS refers to this program as the Open Payments Program.

Physicians have no way to protect themselves from fraudulent reporting until now!  Currently, a healthcare provider has the ability to monitor what's being reported and refute transactions they feel are inaccurate (from prior years reporting submissions.  Discovering the fraudulent data and refuting the Open Payments report can be extremely time consuming and costly to do.  VALIDU offers healthcare providers protection from false reporting at no cost.  The way this works is when a representative wants to setup a meeting with you, make sure they're signed up with VALIDU.

*Information provided derived from 2016 Report to the Nations and American Medical Association