Fraud involving pharmaceutical companies and healthcare providers constitutes a major source of economic waste affecting countries around the world. In spite of increased awareness of the problem and the application of sophisticated anti-fraud mechanisms, individual actors and agencies continue to defraud public and private health systems.

With rapidly ageing populations and the increased costs of providing long-term care, placing substantial pressure upon already overburdened health and social care sectors, healthcare spending will continue to increase worldwide. Unfortunately, this will also bring increased fraud schemes, as fraud perpetrators follow the money – and healthcare presents a target-rich environment. Quantitative data indicate that healthcare fraud has already risen starkly. The World Health Organisation (WHO) estimates that, where losses have been measured and the types of health expenditure have been covered, the average annual cost of fraud totals 7.29 per cent of healthcare budgets (Gee and Button, 2014).

CRI Group’s fraud investigators (including forensic accountants and Certified Fraud Examiners) look for red flags and vulnerabilities that may indicate healthcare fraud. CRI Group’s experts have uncovered schemes including billing for services not rendered, up-coding of services, up-coding of items, duplicate claims, unbundling, excessive services, unnecessary services, kickbacks and more. In addition, pharmaceutical companies face the threat of counterfeit medications, which can lead to major financial loss, not to mention dangerous consequences for patients. This is why the strictest measures and prevention strategies are needed for any pharmaceutical or healthcare organisation. Learn more about our solutions for your business.

TOP PICKS FOR YOU

Top 10 Bribery & Corruption Stories of 2020 (so far)

Even with much of the world under partial lockdown during the COVID-19 pandemic, there’s been no shortage of bribery and corruption cases through the first half of 2020. Each of these stories makes it clear that organisations must have proper controls in place to prevent bribery and corruption. ISO 37001 Anti-Bribery Management Systems standard provides [...]

Countering Bribery & Corruption in the Public & Private Sectors

Anti-Corruption Culture, Risk Assessment, auditing & Compliance The primary aim of this study was to conduct investigative research into two recent case studies in order to demonstrate effective and adequate applications of Anti-Corruption procedures based upon specific case-level outcomes. Over the course of this exploratory research, the following core objectives have been accomplished: To compare and […]

Screening employees worldwide – what are cultural barriers?

The COVID-19 has resulted in an exponential growth in connectivity between people around the globe. As the workforce of many organisations continues to work from home it also becomes more globalised. However new challenges have risen in maintaining an effective and compliant employment background screening program. To measure the pulse of human resources during a […]