What is Upcoding?
Upcoding occurs when a health care provider seeks reimbursement using a fraudulent CPT code that provides a higher reimbursement than the CPT code which corresponds to the services actually rendered to a Medicaid or Medicare patient.
SEC Whistleblower Rules [2020 Update]
Recently the SEC amended its current rules governing the Dodd-Frank Act whistleblower law, which now requires the Commission to pay rewards in the range of 10% to 30% of any “sanctions” obtained by the SEC in administrative, civil or criminal enforcement proceedings.
Report Police Brutality
As a state or municipal police officer, you have two types of protection from retaliation for blowing the whistle on misconduct in your department: The First Amendment and your state’s whistleblower laws.
What is FOIA?
Any person can file a FOIA request, including U.S. citizens, foreign nationals, organizations, universities, businesses, and state and local governments. If you are a federal employee, it is imperative for you to not use government time or equipment when filing a FOIA request.
Department of Labor Whistleblowers: Expert Tips to Win Your Retaliation Case
Numerous federal laws prohibiting private companies from firing whistleblowers require employees to file their initial complaint with the U.S. Department of Labor (“DOL”), not in federal court.
What is Money Laundering?
Money laundering is the process of taking large amounts of illegally obtained funds and making their source seem legitimate. Money earned through criminal activity is considered “dirty,” and through money laundering it becomes “clean.” Once cleaned, the money can be used without being traced back to the criminal activities it originated from.
DOJ FCPA Guidance on Foreign Securities and Commodities Violations
In March 2019, the CFTC issued an Enforcement Advisory indicating that, for the first time, it would be focusing investigative resources on foreign corruption as it relates to violations of the Commodity Exchange Act. As an activity regulated by the CFTC, commodities-related foreign corruption now falls within the gambit of violations for which a whistleblower may be eligible for an award should their tip lead to a successful enforcement action.
What are Kickbacks?
Kickbacks often play a crucial role in fraud schemes designed to swindle taxpayer dollars from the United States Government. It is a general term used to describe the corrupt practice where illegal payments are made to garner preferential treatment and can be thought about as a form of bribery.
What is The Fraud Triangle?
The Fraud Triangle is a tool used by anti-fraud professionals to identify conditions that could motivate individuals, corporations, or even entire industries to engage in fraudulent activity. It is comprised of three risk factors, (1) motivation, (2) opportunity, and (3) rationalization.
Sarbanes-Oxley Act Whistleblower Protections And Rewards
Congress passed the Sarbanes-Oxley Act (“SOX”) to address significant securities and accounting frauds that triggered the collapse of two multibillion dollar publicly traded companies, ENRON and WORLDCOM, in 2001-02.