2016 Fraud Trends in the Healthcare Industry
Posted on 06.28.16
By Matthew O. McDonald, CPA/CFF, CFE, Partner
The Association of Certified Fraud Examiners recently published its biennial “Report to the Nations on Occupational Fraud and Abuse”. One of the stated goals of the report is to provide awareness of fraud risk an organization may have to deal with. The 2016 global fraud study highlights the current trends for those with an interest in reducing the threat of occupational fraud.
Highlights from those participating in 2016 report include the following:
- Estimated loses for a typical organization was 5% of revenues in a given year
- An average loss per case was $2.7 million, with total loses on all cases exceeding $6.3 billion (with a median loss of $150,000, and 23.2% of losses exceeding $1 million)
- Asset misappropriation occurred in over 83% of the cases
- Financial statement fraud occurred in less than 10% of the cases
- Corruption occurred in approximately 35% of the cases
- The medium time duration for a fraud was 18 months
- Perpetrators in over 94% of the cases took steps to conceal the fraud, with the most common methods were creating and altering physical documents
- Tips was the most common detection method (approximately 39% of the cases)
- The manufacturing industry was one of the most representative sectors of cases reported (along with banking and financial services and government and public administration)
- The perpetrator’s level of authority was strongly correlated with the size of the fraud
- The more individuals involved, the higher the losses tended to be.
- Single perpetrator - $85,000 loss
- Two perpetrators - $150,000 loss
- Three perpetrators - $220,000 loss
- Four perpetrators - $294,000 loss
- Five or greater - $633,000 loss
- 7% of victim organizations decided not to refer their fraud cases to law enforcement
For healthcare, number of cases and median losses are as follows:
|Industry||Cases||% of Cases||Median Loss|
The frequency of the schemes used in perpetuating the frauds by industry are as follows:
|Cash on Hand||11.1%|
|Financial Statement Fraud||13.2%|
(Note: Yes, these do not add to 100%. More than one scheme may have been identified in particular cases.)
Trends in the implementation of anti-fraud controls worldwide include establishing hotlines, conducting fraud training for employees or managers/executives, establishing of anti-fraud policies and codes of conduct, strengthening management review, and performing surprise audits.
The complete 2016 Report covers more than 90 pages of information and the above is just a snapshot of facts gleaned from its detail. You can get more information and view the entire report at www.acfe.com/rttn2016. Should you have specific questions pertaining to your organization and anti-fraud measures, please contact your Keiter service provider or 804.747.0000 | Contact us.