Posts Tagged ‘Fraud’

More Fraud Protection Needed on eBay

More Fraud Protection Needed on eBay










(PRWEB) February 27, 2006

Strictly embargoed until Saturday 25 February 2006 at 00:01 hrs

Martin Chapman 020 7770 7373

eBay: buyer beware

eBay should be more proactive in the fight against fraud, says Computing Which?

eBay-related fraud is occurring at an alarming rate. About 130 crimes* citing eBay are reported in London every month to the Metropolitan Police. This level of crime is thought to be mirrored across the UK.

eBay does take measures to protect its customers. For example, all auction pages contain a Safety Centre link. But finding the tiny text link at the foot of the page is “like looking for a needle in a haystack”, according to one researcher.

Police welcome eBay’s anti-fraud measures, such as secure payment service PayPal.** But these measures can only go so far and educating people on the dangers of eBay is equally important. Winning an auction might feel like a victory, but the prize is a chance to buy unseen goods from a total stranger.

And the risk of fraud is increasing; according to the police, criminals are turning away from activities such as drugs and robbery in favour of high-volume, low-risk crime such as that found on eBay.

Detective Chief Inspector Stuart Dark of the Met is working with eBay in the fight against fraud and encouraging them to be proactive, rather than just reacting to illegal or fraudulent transactions after the event.

Jessica Ross, editor, Computing Which?, says:

“Many people see eBay as a bit of fun, like Friends Reunited, and no one’s denying that it’s quick and easy to use. But there’s plenty of opportunity for criminals to cash in too.

“eBay needs to educate people about the dangers of using the site. This 21st century car boot sale attracts more than a few dodgy characters and gangs can ‘earn’ huge amounts defrauding everyday eBayers.”

Computing Which? calls on eBay to:

Be proactive in identifying illegal or counterfeit items for sale on its site

Warn customers about the dangers of fraud

Stop the unlicensed selling of medical products such as contact lenses

Make the Safety Centre prominent on auction pages

There is more information about this story at Which? News http://www.which.co.uk/news/computersandinternet/06/feb/ebay-fraudreport.html


Ends –

Notes to editors

*129 crimes specifically mentioning eBay were reported in London to the Metropolitan Police’s economic crime unit Sterling every month in the 18 months til October 2005.

**PayPal is much safer than money transfers. The service, owned by eBay, allows customers to send and receive money online without giving bank account or credit card details to strangers.

The full article contains advice on how to stay safe on eBay. For a copy of the article, contact Martin Chapman.

# # #






















Vocus©Copyright 1997-

, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.









Cigna On ?Prompt Pay Discount? Fraud? “Down From $2 Million/Month To $200 Thousand/Month” For A Hospital Pay

Cigna On “Prompt Pay Discount” Fraud? “Down From $ 2 Million/Month To $ 200 Thousand/Month” For A Hospital Pay











Hanover Park, IL (PRWEB) January 27, 2012

ERISAclaim.com offers webinars to examine the latest federal court development in an ERISA lawsuit between CIGNA and an out-of-network (OON) hospital, with $ 20 million UCR claim by a hospital and a claim for alleged multi-million dollar prompt pay discount fraud (“fee forgiving”) by Cigna. After the court permitted the hospital’s claim to proceed against Cigna on 03/02/2011, Cigna counter sued the Hospital with a fraud claim against the hospital, under a Cigna antifraud “fee forgiving protocol” to reduce the hospital pay “down from $ 2 million/month to $ 200 thousand/month”. While the Court has yet ruled on the merits of all claims by either party, the court documents show that Cigna has been fully implementing the new “fee forgiving protocol” as an antifraud initiative to deny all out-of-network provider claims, including the alleged “prompt pay discount” fraud.

The Court Case Info: North Cypress Medical Center Operating Co., Ltd. et al v. Cigna Healthcare et al, Case 4:09-cv-02556, Filed: 08/11/2009, United States District Court Southern District of Texas Houston Division.

ERISAclaim.com offers in-depth analysis and timely Court-Watch on this case, as this “ERISA v Discount Fraud” court battle will likely represent the No. 1 health claim denial nationwide for all OON patient and provider claims for 2012, especially in the deductible seasons. It is impossible that every provider can collect every dollar of deductible and co-insurance from every patient in this economy with recession and unemployment rates, while 77% Insured Americans paid for out-of-network coverage in private sectors.

“Cigna will deny ALL OON Claims “in total” with ‘fee forgiving’, while no provider can collect 100% from every patient 100% of the time, therefore this Court case is for every OON patient and provider in USA,” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

(http://www.cigna.com/health/provider/medical/forms/pdf/Participant_disclosure_form.pdf)

ERISAclaim.com will also discuss compliant proactive ERISA discount practices and ERISA / PPACA appeals for all claims denials and delays.

According to the Court documents, on March 2, 2011, the federal court permitted the hospital’s ERISA lawsuit to proceed.

According to the Court Document, on November 17, 2007, CIGNA filed a counter-lawsuit against the hospital for alleged “prompt pay discount” (“fee forgiving”) fraud, among other things, as a part of its defense, in the Court:

“This action arises from an ongoing scheme by NCMC to defraud CIGNA through a practice known as “fee forgiving.”

“NCMC’s so-called business model wrecks these incentives. Instead of collecting the co-insurance from CIGNA plan members that their plans require them to pay, NCMC waives those payments. NCMC tells CIGNA plan members that it will bill them as if they were seeing an in-network provider, eliminating any financial difference to the member between using NCMC and using another provider in CIGNA’s network. On top of this, NCMC offers these plan members over-the-top “hotel-like accommodations,” unlike those in any traditional hospital, including “all private patient suites with upscale room accommodations, including trim, flat screen televisions, private baths, and wireless internet.”

“Defendants deny the allegations of the third sentence of paragraph 30, except admit that one CIGNA employee wrote an email on or around February 18, 2009 that stated in part “spend at North Cypress Medical Center has come down from $ 2 million/month to $ 200 thousand/month so all of our hard work is paying off and the pressure is being felt by the physicians in the area as well as NCMC, which is a good thing;” Defendants respectfully refer the Court to that email.”

On December 14, 2011, the plaintiff hospital filed a motion to dismiss CIGNA counterclaim, asserting ERISA preemption.

On Jan 11, 2012, the defendant Cigna filed defendants’ response in opposition to plaintiffs’ motion to dismiss defendants’ counterclaims.

According to Cigna Website, Cigna will deny all OON claims “in total” with “fee forgiving”, including “prompt pay discount” (http://www.cigna.com/health/provider/medical/forms/pdf/Participant_disclosure_form.pdf):

“Notice to Participant regarding “fee forgiving” by providers that do not participate in the CIGNA HealthCare network.

Some non-participating providers may offer to waive the amount that you are obligated to pay when you use your out of network benefits by stating that that they will “accept what insurance pays as payment in full.” This conduct may impact your benefit claim. The amount waived may adversely affect the amount of the benefit under your plan. Claims submitted by providers that engage in fee forgiving may be denied in total or you may be required to pay the non-participating provider and then file a claim for reimbursement.

If a non-participating provider offers to waive or forgive any part its charges, please notify the CIGNA HealthCare Special Investigations Hotline at 1.800.667.7145”

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:

http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

###











Attachments































Vocus©Copyright 1997-

, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.









Categories