i-Sight Investigation Blog Weekly Review

September 10, 2010   |   Tags: , , , ,  

BP released two pretty big reports throughout the past week. On the i-Sight blog this week, we discuss the reports from BP, as well as how to develop standout ethics and compliance policies. We also announce our attendance at a number of health care fraud conferences with Thomson Reuters. Enjoy!

Tuesday:

“You’ve heard it before- a strong ethics and compliance program begins with a top notch workplace ethics and compliance policy. But do any of these sources ever tell you exactly what makes an ethics and compliance policy “top notch”? Most of the time, the answer is no, which is why I have decided to dedicate this post to helping you better understand the elements of a top notch ethics and compliance program. It’s important to understand that each company’s ethics and compliance policy will be different, as policies are built around a company’s processes and is influenced by the industry in which it operates. However, there are common elements that must be included in every company’s ethics and compliance policy- it’s the “little extras” that are included that separate the top notch ethics and compliance policies from the not-so-stellar ones.”

Wednesday:

“The Deep Water Horizon explosion and the massive oil spill into the Gulf of Mexico, made it clear that BP- and the rest of the oil industry, have a lot to learn. Almost six months after the spill, BP has issued a report for the U.S. Bureau of Ocean Energy Management, Regulation and Enforcement. The report is titled “Deepwater Horizon Containment and Response: Capabilities and Lessons Learned,” and describes what went down during the Deep Horizon incident and what is being done to ensure an event like that doesn’t happen again. This morning, BP released another report. The new report is based on findings from the internal investigation at BP that was launched to determine the causes of the explosion and spill.”

Thursday:

“The signing of the Universal Health Care Bill in the US brought to light the need for solutions to detect and prevent health care fraud. Payment recapture initiatives were revamped earlier this year throughout the US and are predicted to put at least $2 billion over the next three years back into taxpayer pockets. As controls surrounding health care fraud detection and prevention are tightened, it’s likely that there will be a rise in the number of health care fraud related investigations. Employers, medical professionals, insurance companies and all other parties in the health care industry need to be prepared to handle increasing case loads.”

Fighting Health Care Fraud With Solutions from Thomson Reuters and i-Sight

September 9, 2010   |   Tags: , , , , , , ,  

The signing of the Universal Health Care Bill in the US brought to light the need for solutions to detect and prevent health care fraud. Payment recapture initiatives were revamped earlier this year throughout the US and are predicted to put at least $2 billion over the next three years back into taxpayer pockets. As controls surrounding health care fraud detection and prevention are tightened, it’s likely that there will be a rise in the number of health care fraud related investigations. Employers, medical professionals, insurance companies and all other parties in the health care industry need to be prepared to handle increasing case loads.

Thomson Reuters offers a best in class solution for health care fraud detection, abuse and waste, while i-Sight Case Management Software from Customer Expressions is a best in class solution for managing health care fraud investigations. Over the next few months, we will be on the road with our friends at Thomson Reuters, attending a number of health care fraud conferences throughout North America.

Ray Gerard, President at Customer Expressions stated:

Health care fraud is an epidemic. In 2009 alone, an estimated $54 billion was lost due to improper Medicare and Medicaid payments. As efforts to tighten health care fraud controls in the US are put into place, technology and software solutions, including i-Sight Case Management Software, can be used to identify repeat offenders and investigate health care fraud allegations.”

Where to Find Us

A variety of organizations have been created to bring awareness to the issue of health care fraud. Each year, many of these groups hold conferences to bring health care professionals and industry leaders together with companies- such at i-Sight and Thomson Reuters, that have developed solutions targeted specifically at fighting health care fraud. Here’s a list of the upcoming conferences organized by these groups that we will be co-exhibiting at with the Thomson Reuters team:

  • The 26th Annual NAMPI Conference, hosted by the National Association for Medicaid Program Integrity. The conference takes place in New Orleans, Louisiana from September 12-15.
  • Raise the Ante Against Health Care Fraud, the Annual Conference held by the Canadian Health Care Antifraud Association. The conference takes place on September 14th and 15th in Niagara Falls, Ontario, Canada.
  • The 2010 NASMD Fall Conference, held by the National Association of State Medicaid Directors, from November 8-10 in Arlington Virginia.
  • The National Health Care Antifraud Association’s (NHCAA) Annual Training Conference. The conference is held in Las Vegas Nevada from November 16-19.

Some of the topics to be presented and discussed at the conferences this year include:

  • Conducting health care fraud investigations and report writing.
  • Top health care challenges and risks.
  • Health care fraud in the UK, US and Canada.
  • Investigating disabilities and health care fraud.
  • Health care fraud schemes and trends
  • Medical identity theft.
  • Impact of fraud on the health care industry.

i-Sight Ethics and Compliance Software on Display at the ECOA Business Ethics and Compliance Conference

September 2, 2010   |   Tags: , , , , , , , , , , , , ,  

September is shaping up to be a busy month for us at Customer Expressions, as we announce today that we will be exhibiting the i-Sight Compliance and Ethics Investigation Software at the 18th annual Business Ethics and Compliance Conference. The conference is hosted by the Ethics & Compliance Officer Association and this year it’s being held in Anaheim, California from September 21-24th. We attended this conference last year when it was held in Chicago and are glad to be returning again this year.

The Business Ethics & Compliance Conference is the world’s largest, multi-industry gathering of ethics and compliance officers. Distinguished keynote speakers, leading subject matter experts, and the most prominent ethics and compliance officers in the field will address critical issues facing ethics and compliance practitioners today. This year’s keynote speakers include Sharon Allen, Chairman of the Board at Deloitte LLP, Dr. SH Lee, Chairman and CEO at Samsung Tesco Homplus and Greg Andres, Deputy Assistant Attorney General, Fraud Section at the US Department of Justice.

Some of the key issues to be discussed at this year’s conference include:

“With recent events and the economic downturn, the focus on ethics and compliance is stronger now than ever before. Many ethics and compliance departments are small in size when compared to the number of people within their organization. As legislation and policies demand tighter controls over ethics and compliance related issues, ethics and compliance departments require affordable, effective solutions that make their lives easier.” said Joe Gerard, Vice President at Customer Expressions.

Mr. Gerard also states:

“Each person we speak with indicates a desired need for a system configured around their company’s specific processes- and we respond. We build a unique version of i-Sight for each client, which allows them to use their language, as well as a system that reflects their corporate structure, review procedures and reporting hierarchy. This increases the rate of adoption, improving the efficiency and quality of investigations.”

The ECOA is a member-driven association exclusively serving individuals responsible for developing and maintaining compliance, and business conduct programs within their companies. Dedicated to building trust and organizational integrity worldwide, the ECOA is the most-respected group of ethics and compliance practitioners in the world. By gathering those new to the field along with seasoned professionals, the ECOA facilitates peer-to-peer learning and helps to foster a global commitment to business ethics and integrity. Over 1,200 ECOA members represent nearly 500 organizations worldwide in over 30 industries.

To view the preliminary schedule for the conference, visit the ECOA website to download the PDF.

Learning from Ethical Lapses

August 19, 2010   |   Tags: , , , , , , ,  

H-P Ouster a ‘Teachable Moment’- The Wall Street Journal

There have been countless articles written since August 6th, when HP ousted their now former CEO, Mark Hurd. In particular, this article from the Wall Street Journal focuses on the importance of proper expense reporting and how the HP example has already served as a lesson in numerous workplaces. The article features comments from ERC President, Patricia Harned, in which she states:

“Companies will often use very public cases as a teachable moment to remind employees why certain policies are so important.”

The article discusses the increased harshness faced by executives who make poor, unethical decisions, as they are supposed to be leaders and set an example for their employees. The article also features a great discussion about the importance of administrative staff in detecting inaccurate or unjust expenses.

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Whistleblower Protection for Oil-Rig Workers

August 3, 2010   |   Tags: , , , ,  

Oil-Rig Workers Gain Whistleblower Protections in House Bill- Bloomberg Businessweek

A new law has been passed in the US as a result of the devastating BP oil spill in the Gulf of Mexico. The House passed a law to protect employees working on oil-rigs from retaliation for bringing forward health and safety concerns. According to the article, the bill it titled H.R 5851 and “prevents companies from firing employees who report safety violations and allows employees to appeal perceived retaliation to the Labor secretary.” This bill will help employees feel safer in standing up for their safety and will hopefully deter events such as the massive oil spill from occurring again in the future.

EEOC Annual Report on the Federal Work Force

July 27, 2010   |   Tags: , , , ,  

EEOC Releases Federal Work Force Report- EEOC

Yesterday, the EEOC released their Annual Report on the Federal Work Force for Fiscal Year (FY) 2009. According to the EEOC, the purpose of the report is to assess the current conditions of equal employment opportunity within the US federal workforce. The report looks at trends surrounding workforce composition and complaints of employment discrimination. The report for fiscal year 2009 concludes that complaints of discrimination- gender, race, religion, sex, etc., have increased. It has also been reported that the average time to conduct and investigation has increased.  The results of these findings can be used to help federal employers address issues of concern and provide guidance for implementing best in class equal employment opportunity (EEO) programs.

Increasing Demand for Anti-Corruption Services

July 23, 2010   |   Tags: , , , , ,  

Anti-Corruption Work Booms as Business Grows Overseas- Silicon Valley / San Jose Business Journal

This article by Eli Segall discusses the implications of American companies conducting business overseas where bribery and corrupt payments are frequently made to gain business. These situations have resulted in an increase in FCPA related violations and enforcement. The article goes on to talk about the growth of firms, such as Deloitte and KPMG, which offer anti-corruption compliance services. As government regulators crack down on companies found guilty of violating anti-corruption laws, organizations are taking a proactive approach by seeking out services to help them avoid making mistakes that could land them in court next.

UK Bribery Act Enforcement Date Announced

July 22, 2010   |   Tags: , , , ,  

Bribery Act in Force Next April- Telegraph.co.uk

The British Government has announced that the UK Bribery Act will be in full effect as of April 2011. Originally, the Act was supposed to be in place by October of this year. The new laws are much tougher than existing laws in the UK, maximum prison sentences have increased to 10 years and there’s no limit as to how much a company can be fined for violating the law. Once the Bribery Act is in place, companies will only have three months to ensure they have the required policies in place to comply with the new laws. The article urges companies to begin implementing new anti-corruption policies and practices immediately.

The article states:

“Speaking in the House of Commons on Tuesday, Ken Clarke, the Justice Secretary, vowed ‘effective implementation’ of the Bribery Act, which for the first time will make companies liable for the corrupt activities of associated third parties as well as their own staff.”

Advice for Maintaining and Improving Ethics

July 21, 2010   |   Tags: , , , , ,  

Improving Compliance in an Economic Slowdown- Corporate Compliance Insights

This article by John Avellanet provides useful tips business leaders can use to ensure their company remains compliant regardless of the state of the economy. There have been many reports, studies and articles written about the ability for compliance to be maintained throughout the recession. Many companies cut costs during economic slowdowns, with ethics and compliance being one of the first budgets on the chopping block. The author discusses three pieces of advice- prioritizing budget activities, trimming expenses and learning from the past, which offer smarter solutions for business leaders.

Goldman Sachs Reaches Settlement With the SEC

July 19, 2010   |   Tags: , , , , ,  

Goldman Settles Its Battle With SEC – The Wall Street Journal

Last Thursday, Goldman Sachs was handed on of the largest fines in Wall Street History. Goldman Sachs settled with the Securities and Exchange Commission- to the tune of $550 million. Goldman Sachs was charged with securities fraud. Some believe Goldman Sachs is getting off easy with the agreements in the settlement. This WSJ article talks about the fact that Goldman Sachs doesn’t have to get rid of top level executives and the “record-setting penalty is equivalent to just 14 days of profits at Goldman in the first quarter.”

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