Jeffrey Robinson on the "New Fraud"

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INTERVIEW WITH JEFFREY ROBINSON

Renowned Financial Crime Author and closing ceremonies keynote speaker at the 17th Annual ACFE Canadian Fraud Conference

Nov. 27-30, Toronto

Why do you call your topic, "The New Fraud?"?

You know those movies where there's some asteroid heading towards the earth and the heroine says, "This is what killed the dinosaurs," and as the hero takes her in his arms, he laments, "This is what could kill the human race, too." Scary? Yes. But only a remote possibility. Yet, when you hear that over the next 12 months, every man, woman and child in the country will be targeted by professional fraudsters multiple times. And when you hear an estimated one in nine people will lose money as a result of fraud... that ain't remote! And that's terrifying. Consider this: Corporate fraud is pandemic. And yet, corporations are reluctant to prosecute for fear of alarming their clients, shareholders and board members. Fraud against the government (start with Medicare) is at an all-time high when much of the good guys' attention is being directed away from non-violent crimes; and the economic crisis has thrown the field wide open to amateurs, weekend-fraudsters and wannabees. Put another way, if fraud were a disease, the president would have to declare a national emergency. We're living in unique times. Maybe I should call it "new and improved."

What is unique about the group of fraud fighters you address?

The 9-11 attacks polarized law enforcement. Ten years later, we're still trying to protect the streets so that Grandma doesn't get hit over the head and have her purse stolen and also protect the Homeland from future attacks that are, clearly, being planned. That's left a no-man's land in the middle where the good guys are over-burdened, under-budgeted and under-staffed, and the bad guys believe they can flourish. What's more, statistical reporting inadvertently prioritizes triage. Why would a detective take on a case unless it's big enough and with a probable success rating of, say, 50 percent? (And in some cases, the bar is often higher). No one wants open cases and unsolved crimes on his or her books. Don't believe me? Go to your local precinct in Lincoln, Neb., (or Eufala, Ala,, or Pocatello, Idaho) and tell the sergeant at the desk that you've been defrauded of $350 by a Nigerian prince in Lubeck, Germany, and see how far you get.

What do you most hope attendees will take away from your address?

There is an old Irish expression - "begrudgers." Those are the people whose role in life it is to remind you, "It can't be done," and, "Don't bother," and, "Stop wasting everyone's time," and, "Who do you think you are, Colombo?" Unfortunately, they're everywhere. There are so many of them and they say it so loudly and frequently that, after a while, you start thinking to yourself, maybe they're right. What do I want attendees to take away from my little bit in all of this? That ACFE members are the final frontier. If you don't do it, it's simply not going to get done. And that there is an old Latin expression --- "Illegitimi non carborundum." It means, "Don't let the bastards grind you down."

Read more about Jeffrey and the other keynote speakers at this year’s ACFE Canadian Fraud Conference here.

Rising to the Challenge

GUEST BLOGGER

James D. Ratley, CFE, ACFE President

Remember this scene in The Godfather, Part II? In 1959, pre-Castro Havana, mafioso Hyman Roth boasts, “We now have what we’ve always needed – partnership with a government…We’re bigger than U.S. Steel!”

Real-life gangster Meyer Lansky actually made that claim. Rising to the challenge, Congress and President Nixon created the Racketeer Influenced and Corrupt Organizations Act (RICO) in 1970.

Fast forward to New York’s Tribeca 2010 Film Festival, in which a Russian documentary, Thieves by Law (Vory v Zakone), earned praise for its chilling interviews of wealthy, vicious underworld bosses. These vory – high-ranking criminals – are among those who banded together in communist prisons and strictly adhered to their own law – a thieves’ code of conduct.

When the Soviet Union collapsed, released vory drove forcefully into the resulting power vacuum, establishing alliances with corrupt government officials and obtaining funding for criminal enterprises. Many left their homeland on cross-border quests for plunder. One of their specialties is healthcare fraud.

This Time It’s Different

The movie may be out, but the vory are far from defeated. Case in point: On Oct. 13, the U.S. Department of Justice indicted 44 alleged members and associates of an Armenian-American organized crime ring on charges related to more than $100 million in fraudulent Medicare billing – the largest such scheme ever perpetrated.

The defendants allegedly stole the identities of dozens of physicians and thousands of Medicare beneficiaries while operating at least 118 phony clinics in 25 states. The primary suspect, a California resident, migrated to the United States from Armenia, a former Soviet republic; the FBI believes he is a vor.

Meanwhile, our nation’s healthcare system is undergoing enormous changes under The Affordable Care Act of 2010. The new law encourages doctors and hospitals to join forces in controlling medical costs, and offers bonuses if they succeed.

Some provider networks are eager to consolidate without undue hindrance. As quoted in the New York Times, Charles N. Kahn III, president of the Federation of American Hospitals, said, “To provide a fertile field to develop truly innovative, coordinated care models, [related] fraud and abuse laws should be waived altogether.”

Conflicting pressures for stronger anti-fraud resources and more economical healthcare systems will put fraud fighters to the test.

Let’s rise to the challenge. Let’s be extra alert for the signs and agents of Medicare and Medicaid fraud. That means keeping up with the latest detection and prevention techniques. For those who need it, upcoming courses like the ACFE’s Principles of Fraud Examination and Healthcare Fraud offer comprehensive practical instruction.

CFEs, working together, will help America overcome this challenge.