UNIT 5 HEALTH CARE FRAUD

Health care fraud is a serious crime which is investigated by the FBI's Financial Crimes Section [hereinafter FCS]. The mission of the FCS, in the FBI's words, is to oversee the investigation of financial fraud and to facilitate the forfeiture of assets from those engaging in federal crimes. The FCS is divided into four sections, one of which is the Health Care Fraud Unit [hereinafter HCFU]. The HCFU oversees investigations that target individuals and organizations who defraud the public and private health care systems. Among the activities that are investigated by the HCFU are: billing for service not rendered billing for a higher reimbursable service than performed (also known as upcoding) performing unnecessary services kickbacks unbundling of tests and services to generate higher fees durable medical equipment fraud pharmaceutical drug diversion outpatient surgery fraud, and internet pharmacy sales. The HCFU estimates that fraudulent billings to health care programs comprise between 3 to 10 percent of total health care expenditures. Furthermore, the HCFU has noticed that the most significant trend in recent health care fraud cases is the willingness of medical professionals to risk patient harm in their schemes. Current fraud schemes consist of traditional schemes that involve fraudulent billing, but also incorporate unnecessary surgeries, diluted cancer drugs, and fraudulent lab tests. In exchange for kickbacks, some patients will willingly undergo unnecessary and unwarranted medical procedures to generate fraudulent claims and profits.

A person charged with a health care fraud can be punished by a fine, imprisonment for not more than 10 years, or both. If the violation results in serious bodily injury that person can be punished by a fine, imprisonment for not more than 20 years, or both. If the violation results in death, that person can be punished by a fine, imprisonment for any term of years or for life, or both.
Note: Long compound text reference words are specific to formal, legal style; for those who are nor familiar with these terms, here is a short list of examples, with their definition and Romanian translation: hereinafter herein hereby hereunder henceforth notwithstanding = stated later in this document = in this document = in this way or by this letter = under this heading or below this phrase = from this time on = in spite of = menionat n continuare (ntr-un document) = aici, n acest document = prin aceasta, n felul acesta = mai jos = de acum nainte, n viitor = dei, cu toate acestea

I. Match the new words and expressions in column A with their Romanian equivalents in column B: A 1. health care fraud 2. to oversee the investigation 3. the forfeiture of assets 4. to defraud 5. billing for service not rendered 6. reimbursable service 7. kickback B a. a defrauda/nela/escroca b. a executa separat teste/servicii n vederea taxrii unor tarife mai mari c. serviciu rambursabil d. taxri frauduloase e. fraud n cadrul sistemului medical f. a fi supus unor proceduri medicale nejustificate g. lezare corporal grav

8. to unbundle tests/services to generate higher fees 9. outpatient surgery fraud 10. fraudulent billings 11. to undergo unwarranted medical procedures 12. serious bodily injury

h. a supraveghea/controla investigaia i. mit/bani dai contra unui serviciu j. confiscarea bunurilor k. fraudarea serviciilor operatorii pentru pacienii externi l. taxarea unor servicii neprestate

II. Match the four definitions below with their corresponding words in the box, to distinguish between different forms of bribes: bribe boodle kickback hush-money

1. = illegal commission paid to someone (especially a government official) who helps in a business deal; 2. = to promise, offer, or give something, usually money, to a person to procure services or gain influence, esp. illegally; 3. = money given to a person, such as an accomplice, to ensure that something is kept secret; 4. = (slang) money or valuables, esp. when stolen, counterfeit, or used as a bribe. III. Provide the nouns derived from the following verbs: verbs 1. to investigate 2. to forfeit 3. to facilitate 4. to engage 5. to estimate 6. to involve 7. to incorporate 8. to punish 9. to injure 10. to render nouns 1. investigation 2. 3. 4. 5. 6. 7. 8. 9. 10.

IV. Answer the following questions, after re-reading the text: 1. Who investigates health care frauds? 2. What do FCS and HCFU stand for? 3. What is the mission of the FCS? 4. What is the mission of the HCFU? 5. Which types of health care frauds affect patients the most? 6. Why do some patients willingly undergo unwarranted medical procedures? 7. What is the punishment for a person charged with a health care fraud? 8. What is the punishment for a health care fraud when the patient is seriously injured? 9. What is the punishment for a health care fraud when the patient dies? 10. What reasons do medical professionals have to risk patient harm in committing frauds?

V. Translate the following fragment into Romanian: Current fraud schemes consist of traditional schemes that involve fraudulent billing, but also incorporate unnecessary surgeries, diluted

cancer drugs, and fraudulent lab tests. In exchange for kickbacks, some patients will willingly undergo unnecessary and unwarranted medical procedures to generate fraudulent claims and profits.

Remember the use of should + infinitive as an Analytic Subjunctive after: verbs of command and control: advise, agree, arrange, ask, beg, claim, command, decide, demand, determine, insist, order, propose, recommend, require, request, rule, stipulate, suggest, urge, etc. it is/was + adjective + that: it is/was absurd, advisable, amazing, better, compulsory, desirable, essential, imperative, important, ludicrous, natural, necessary, recommendable, ridiculous, strange, surprising, etc. so that, in order that, lest, in case, for fear that, in Purpose Clauses. VI. Put the verbs in brackets into the correct should Analytic Subjunctive form: Example: The judge ruled that the jury should withdraw to deliberate upon the verdict. It was absurd that he should have been arrested for such an insignificant act. He began to be worried lest they should have accused him of mortgage fraud crimes. 1. Tax inspectors recommended that new rules against tax evasion .. (introduce). 2. The judge ordered that the court (adjourn) for lunch. 3. The PM demanded that the spokesman . (withdraw) his offending remark. 4. The police officer decided that the pimp .. (call) his lawyer the minute he was arrested. 5. The magistrate directed that the man ... (release) immediately.

6. The police gave instructions that the pedestrians . (not approach) the crime scene. 7. The police issued a warning in order that the public . (not come) in contact with any red-haired, suspicious looking woman. 8. He keeps his precious coin collection in a safe deposit lest his house (burgle). 9. The protesters urged that the defendant . (be released) on bail. 10. I suggested that they .. (take) legal advice long ago. 11. Its incredible that he (go) away with murder after so much effort had been invested in finding hard evidence! 12. Its ridiculous that you (miss) the only testimony that was worth hearing. 13. Its essential that you . (read) the contract before signing it. 14. It was important that he .. (inform) himself on the case, before agreeing to represent his client. 15. Its unbelievable that he . (share) the same cell with another prisoner and (not say) a word to him ever. Remember the Synthetic Subjunctive Be Subjunctive Be-Subjunctive is competing with Analytic Subjunctive in the contexts presented before exercise VI. The only difference is that Be-Subjunctive is preserved in legalistic style, official announcements, parliamentary style and is more frequently used in American English, while the Analytic Subjunctive is preferred in British English. Example: The judge ruled that the jury withdraw to deliberate upon the verdict. It was absurd that he be arrested for such an insignificant act. He began to be worried lest they accuse him of mortgage fraud crimes. VII. Translate the following sentences into Romanian:
Note: The sentences below include more values of Be-Subjunctive that have become obsolete; in most of the cases, Be-Subjunctive has been replaced by the modal verb shall that is used in formulating articles, points of law and legal documents; there are also some examples of May/Might Subjunctives.

1. The police demand that the information be withheld until further evidence. 2. The buyers insisted that the program provide more functions. 3. They put in an application form so that she be accepted at the University of Colorado. 4. It is decided that he take part in the following under-cover mission. 5. It is vital that the Member State in question intervene in the proceedings before the Court of First Instance. 6. It is required that the Court of Justice rule on such applications. 7. It is stipulated that an appeal to the Court of Justice be limited to points of law. 8. So be it; no punishment shall be inflicted upon him! 9. Be that as it may, we shall go on with our plan. 10. Be he who he may think, he has no place here! 11. Suffice it to say that justice has been done, and everybody will bless your name. 12. God save the Court of Justice! 13. Long live the President of the Court of Justice! 14. Justice be hanged! I shall make my own justice! 15. Damn the judges! They are not Gods instruments on earth! 16. Far be it from me to testify against you! 17. May you win this case and many to follow! 18. However much he may charge, he does a great job! 19. However hard I may try, I dont seem to get to the bottom of it! 20. They were afraid that the results might discourage him. VIII. Choose the correct forms of Analytic Subjunctive and Synthetic Subjunctive: 1. It is vital that the defendant . the benefit of the doubt. a) be given b) can be given c) should be give d) is given 2. The judge insisted that the verdict before the Court adjourns for lunch. a) should be pronounced b) being pronounced c) be pronouncing d) will be pronounced 3. Under no circumstances will I disclose the name of my sources! Heaven . ! a) forbids b) forbid c) forbade d) will forbid 4. it to say that she is terribly sorry for what she did. a) Sufficient b) Suffice c) Suffices d) Sufficed

5. . what may, I shall not drop the charges against him! a) Comes b) Coming c) Come d) To come 6. It was out of the ordinary that the judge .. the lawyers representing the plaintiff and respectively the respondent to argue their cases in parallel. a) should ask b) has asked c) should have asked d) to have asked 7. The members of the commission expressed a desire that the participants . in an hour. a) reconvened b) to reconvene c) might reconvene d) should reconvene 8. The suggestion is that we .matters more seriously. a) took b) taking c) should take d) would take 9. I didnt dare tell the truth lest I . arrested for conspiracy crimes. a) should be b) were c) am d) will be 10. It is demanded that the Council . common rules applicable to international transport. a) laid down b) lay down c) should laid down d) lays down 11. Wherever you . , I shall protect you against your enemies! a) goes b) may go c) will go d) are going 12. However difficult this problem , I will solve it in a minute! a) shall be b) will be c) may be d) be 13. . you make the best of you life! a) Should b) Shall c) Might d) May

14. They were worried lest she a prison sentence. a) receives b) should receive c) may receive d) received 15. Far ... it from me to make allegations before having some proofs. a) away is b) is c) should be d) be

UNIT 6 IDENTITY THEFT

Identity theft is one of the fastest growing crimes in the world. The news has been filled with stories about how personal data have been compromised from certain personal information aggregators. The ITADA [Identity Theft and Assumption Deterrence Act of 1998] amended the fraud chapter of title 18 of the United States Code to create a new crime prohibiting the unlawful use of personal identifying information, including, but not limited to, names, social security numbers, and credit card numbers. Identity fraud involves the misappropriation of another person's personal identifying information. Criminals use this information to establish credit in their name, run up debts on another person's account, or take over existing financial accounts. The ITADA directed the Sentencing Commission to "review and amend the Federal sentencing guidelines and the policy statements of the Commission, as appropriate, to provide an appropriate penalty for each offense under section 1028 of title 18. One of the most common method of stealing identities is through the theft of credit card numbers or Personal Identification Numbers [hereinafter PINs]. This method is covered by 18 U.S.C. 1029, which uses the unfortunate terminology of access devices. The Crime It is a crime to do any of the following ten offenses listed in section 1029(a): knowingly, and with intent to defraud, produce, use, or traffic in one or more counterfeit access devices; knowingly, and with intent to defraud, traffic in or use one or more unauthorized access devices during any one-year period, and, by doing so, obtain anything of value aggregating $ 1,000 or more during that period;

 knowingly, and with intent to defraud, possess fifteen or more devices which are counterfeit or unauthorized access devices; knowingly, and with intent to defraud, produce, traffic in, have control or custody of, or possess device-making equipment; knowingly, and with intent to defraud, effect transactions, with 1 or more access devices issued to another person or persons, to receive payment or any other thing of value during any 1-year period the aggregate value of which is equal to or greater than $ 1,000; without the authorization of the issuer of the access device, knowingly, and with intent to defraud, solicit a person for the purpose of either: offering an access device, or selling information regarding or an application to obtain an access device; knowingly, and with intent to defraud, use, produce, traffic in, have control or custody of, or possess a telecommunications instrument that has been modified or altered to obtain unauthorized use of telecommunications services; knowingly and with intent to defraud use, produce, traffic in, have control or custody of, or possess a scanning receiver; knowingly use, produce, traffic in, have control or custody of, or possess hardware or software, knowing it has been configured to insert or modify telecommunication identifying information associated with or contained in a telecommunications instrument so that such instrument may be used to obtain telecommunications service without authorization; or without the authorization of the credit card system member or its agent, knowingly, and with intent to defraud, cause or arrange for another person to present to the member or its agent, for payment, 1 or more evidences or records of transactions made by an access device. I. Check the meaning of the following words and expressions by choosing the right version: 1. In the sentence The ITADA amended the fraud chapter of title 18 of the United States Code , to amend means: a) to alter or revise (legislation, a constitution, etc.) by formal procedure;

b) to make someone pay a certain amount of money exacted as a penalty; c) to judge (something) with disapproval; censure. 2. In the sentence Identity fraud involves the misappropriation of another person's personal identifying information, to misappropriate means: a) to have as one's property/to own; b) to appropriate for a wrong or dishonest use/to embezzle or steal smth; c) to give (a person) wrong directions or instructions. 3. In the sentence Criminals use this information to run up debts on another person's account, to run up debts means: a) to get rid of ones debts by running; b) to pay back ones debts; c) to amass/accumulate or incur debts. 4. In the sentence Criminals use this information to take over existing financial accounts, to take over means: a) to cancel the validity of/ abolish; b) to assume the control or management of; c) to examine/ investigate smth for accuracy. 5. In the phrase to provide an appropriate penalty for each offense, penalty means: a) a handicap awarded against a player or team for illegal play, such as a free shot at goal by the opposing team, loss of points, etc; b) loss, suffering, or other unfortunate result of one's own action, error; c) a legal or official punishment, such as a term of imprisonment. II. Provide the Romanian equivalent for the following phrases: identity theft = social security numbers = credit card numbers = financial accounts = Personal Identification Numbers = counterfeit documents = telecommunications services = scanning receiver = records of transactions =

III. Answer the following questions, using your own words to express personal opinion: 1.Which are the main reasons that determine criminals to commit identity theft crimes? In my opinion/view, I think that 2. Which are the weak points of the social security system that make identity theft crimes possible? I am inclined to believe that 3. Name some of the criminal methods used when committing identity theft crimes. To my mind, 4. Which criteria have been used in distinguishing the 10 particular offences enumerated in the text? It seems to me that 5. What could be done and in which areas to reduce the increasing number of identity theft crimes? To my way of thinking,

IV. Translate the following fragment into Romanian: Identity fraud involves the misappropriation of another persons personal identifying information. Criminals use this information to establish credit in their name, run up debts on another persons account, or take over existing financial accounts. The ITADA directed the Sentencing Commission to review and amend the Federal sentencing guidelines and the policy statements of the Commission, as appropriate, to provide an appropriate penalty for each offense under section 1028 of title 18.

Remember Phrasal verbs Phrasal verbs are idiomatic phrases consisting of verbs plus adverbial particles or verbs plus prepositions. Different from other free combinations or prepositional verbs, where the meaning can be predicted from the meaning of verb and particle in isolation, a phrasal verb has its own meaning, distinct from that of separate words. Therefore, a phrasal verb must be learnt as a whole unit with a particular meaning, and not approximated by the meanings of its components. Examples: She tried to take in her friends. to take in = to deceive [not to bring in] I think you should cut down your traveling expenses. to cut down = to reduce We arranged to meet in front of the cinema but she didnt turn up. to turn up = to come V. Rewrite the following sentences, using the phrasal verbs in the box to replace the verbs in italics and making any necessary changes in word order: keep in with book up think over wear out cut down on cut somebody off let somebody down put something down to do away with check in break away hold on come up with call off break off

1. There are still many countries which have not decided to abolish the death penalty. There are still many countries which have not decided to do away with the death penalty. 2. I can`t possibly reduce his daily allowance. He would attribute this to my decision to hire more staff. 3. I can always count on him. He has never dissapointed me. 4. After several unsuccessful attempts to escape from prison, the prisoner decided to wait till he was to be moved to another prison. 5. How did you find that brilliant idea? 6. Please reflect upon this and let me know. 7. Have you managed to make a table reservation for dinner? Yes, this is the first thing I did after I registered myself at the hotel. 8. I remained in good terms with my relatives, though they tried to disinherit me. 9. The negotiations with the Japanese company have been suspended, consequently, all the meetings with the Japanese clients had to be cancelled. 10. Children sometimes exhaust their parents, especially when asking questions all the time.

VI. Replace the phrasal verbs in italics with an appropriate verb or verbal construction; the first one has been done as an example: 1. I have neither the time nor the courage to go into/to investigate this controversial case. 2. Who will stand in for/ Jane while she is away? 3. Who do you think I ran into/ yesterday? 4. I have a job now, so I no longer live on/_ my parents. 5. The novel which I have been working on for such a long time will eventually come out next month. 6. His coming into/ a big fortune turned out/ to be a blessing in disguise. 7. I wont give your secrets away/ provided that you are through with/ that man once and for ever. 8. He will never come up to/_ her expectations. 9. Go ahead! Ill catch up/_ with you in no time. 10. He has gone through/ a lot lately; but with some effort you will get over/ it. VII. Choose the right version to form phrasal verbs that fit in the context; check the list of the main phrasal verbs selected in the alphabetical order of the adverbial particle present at the end of the book before making your choice: 1. I dont know how you can put . .. such an unbearable situation. a) by with b) up of c) up with 2. The good sales brought . an increase in the employees salaries. a) in b) around c) about 3. I guess the printer has either run .. paper or has broken . a) away with, down b) out of, down c) off with, off 4. Several companies have decided to lay . employees and call .. all investment projects. a) off, off b) out, off c) up, down 5. You have to learn how to .. if you are suffering from high stress levels. a) draw back b) wind down c) hold up

6. My lawyer can bear . the truth of my story with substantial evidence. a) in b) away c) out 7. I called at the restaurant, but all the tables were . up. a) cleaned b) booked c) reserved 8. We tried to bring the unconscious woman .. but without any success. a) round b) up c) over 9. Despite all difficulty, he finally managed to carry the orders he had been given. a) about b) off c) out 10. His joke caught . right away and the public was very excited. a) on b) through c) out 11. The disastrous economic situation of our country . . urgent measures. a) brings about b) lays down c) calls for 12. If nobody comes . a solution soon, we shall go bankrupt. a) up with b) in with c) out with 13. If you don`t know my phone number, you could look it . in the phone directory. a) into b)on c) up 14. Our travel agency will be taken . by a German company. a) in b) out c) over 15. Now it would be a good time to bring the matter of child support in Romania. a) in b) up c) out

16. I have a very urgent message. Could you put me . to Mr. Leigh, please? a) through b) off c) up 17. He put his failure in Court bad luck. a) up to c) back to 19. We cant rule.. this argument for the final hearing. a) out b) down to

18. I must admit it was hard for me not to give .. to his threats. a) away b) out c) in b) off c) down 20. Our plan to call the witness for the defence fell . due to a miscarriage of justice. a) about b) away c) through a) in 21. You are wearing me with your annoying questions! b) out c) over

22. Everybody considered that the judge had a reason to let him .. like that. a) off b) on c) away a) in 23. Why dont you put your claim to be granted the right to a fair trial? b) out c) forward

24. Your Honour, I can stand the defendant! I demand to be heard! a) in for b) up for c) down to 25. Your skillful lawyer will talk him testifying before the jury. a) into b) about c) against