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As manager of the medical claims processing department. Martha Lee was considered one of Beta Magnetic's best employees. She had never missed a day of

As manager of the medical claims processing department. Martha Lee was considered one of Beta Magnetic's best employees. She had never missed a day of work in 10 years, and her department had one of the company's best efficiency ratings. Controls were considered good, including the verification by a claims processor that (1)the patient was a Beta employee, (2) medical treatments were covered in the plan, (3) the charges were within approved guidelines, (4) the cumulative claims for the employee did not exceed $50,000 (paid all claims less than $50,000 but submitted claims more than $50,000 t0 an insurance company), and (5) the calculation for payment was correct. After verification processing, claims were sent to the claims payment department to pay the doctor directly. No payments ever went directly to employees. Lee prepared false claims on real employees, forging the signatures of various claims processors, adding her own review approval, and naming bogus doctors who would be paid by the payment department, The payments were mailed to various post office box addresses and to her husband's business address. Nobody ever verified claims information with the employees. The employees received no reports of medical benefits paid on their behalf. Although The department had performance reports by claims processors, these reports did not show claim-by-claim details. No one verified the credentials of the doctors. As noted, Martha never missed a day of work for vacation or sickness. She was considered an ideal employee. The falsified claim forms were in Beta's files, containing all fictitious data on employee names, processor signatures, doctors' bills, and phony doctors and addresses. The canceled checks were returned by the bank and were kept in Beta's files, containing "endorsements" by the doctors. Lee and her husband were clever: They deposited the checks in various banks in accounts opened in the names of the "doctors." Lee did not stumble on the audit trail. She drew the attention of an auditor who saw her take her 24 claims processing employees out to an annual staff appreciation luncheon in a fleet of stretch limousines. Over the seven years, Lee and her husband had stolen $3.5 million and, until the last, no one noticed anything unusual about the total amount of claims paid.

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