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Fraud 'Possibilities' Are Realities.

I particularly enjoyed Mark Nickerson's article on fraud possibilities in your annual technology issue ("Fraud in a World of Advanced Technologies," June 2019, I wager he's quite aware that "possibilities" are actually realities. In healthcare, the number one reason why medical claims are rejected is because of "insufficient or incomplete" documentation, which now has to take into account rampant record counterfeiting using electronic health records, as documented by several investigations and federal reports. Searching for "healthcare fraud" on the U.S. Department of Justice website will lead to a list of cases involving false claims, which must be backed by patient records now primarily in digital form.

For complex reasons, the usual and customary guardians of records integrity in healthcare are "offline" to varying, but in the aggregate astonishing, degrees. Law enforcement funding for combatting healthcare fraud, for example, has been systematically hobbled over several administrations.

The CPA profession is no stranger to "systematically hobbled" oversight, of course; we share that particular bond of professional burden. Greater interest from CPAs in identifying digital records counterfeiting will be welcomed by all advocates of a more effective and accountable healthcare industry.

Reed D. Gelzer, MD, MPH Newbury, N.H.

The Author Responds

I appreciate Dr. Gelzer's comments and would tend to agree that the potential issues addressed are more likely already realities that have yet to be uncovered. In addition, as the PCAOB is not subject to open government, including responding to any FOIA requests, frauds that may have already been uncovered are almost impossible to determine except at the agency's discretion. He is also correct regarding the potential funding issues for oversight, which simply creates another reason why, in my opinion, the CPA profession must take a greater responsibility toward fraud in general, as well as potential malicious uses of AI.

Mark A. Nickerson, CPA, CMA Buffalo, NY.

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Title Annotation:NEWS & VIEWS: Letters to the Editors
Author:Gelzer, Reed D.
Publication:The CPA Journal
Article Type:Letter to the editor
Date:Aug 1, 2019
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