Banking Fraud – Prevention and Control

Health Care Data

Banking Fraud is posing threat to Indian Economy. Its vibrant effect can be understood be the fact that in the year 2004 number of Cyber Crime were 347 in India which rose to 481 in 2005 showing an increase of 38.5% while I.P.C. category crime stood at 302 in 2005 including 186 cases of cyber fraud and 68 cases cyber forgery. Thus it becomes very important that occurrence of such frauds should be minimized. More upsetting is the fact that such frauds are entering in Banking Sector as well.

In the present day, Global Scenario Banking System has acquired new dimensions. Banking did spread in India. Today, the banking system has entered into competitive markets in areas covering resource mobilization, human resource development, customer services and credit management as well.

Indian’s banking system has several outstanding achievements to its credit, the most striking of which is its reach. In fact, Indian banks are now spread out into the remotest areas of our country. Indian banking, which was operating in a highly comfortable and protected environment till the beginning of 1990s, has been pushed into the choppy waters of intense competition.

A sound banking system should possess three basic characteristics to protect depositor’s interest and public faith. Theses are (i) a fraud free culture, (ii) a time tested Best Practice Code, and (iii) an in house immediate grievance remedial system. All these conditions are their missing or extremely weak in India. Section 5(b) of the Banking Regulation Act, 1949 defines banking… “Banking is the accepting for the purpose of lending or investment, deposits of money from the purpose of lending or investment, deposits of money from the public, repayable on demand or otherwise and withdraw able by cheque, draft, order or otherwise.” But if his money has fraudulently been drawn from the bank the latter is under strict obligation to pay the depositor. The bank therefore has to ensure at all times that the money of the depositors is not drawn fraudulently. Time has come when the security aspects of the banks have to be dealt with on priority basis.

The banking system in our country has been taking care of all segments of our socio-economic set up. The Article contains a discussion on the rise of banking frauds and various methods that can be used to avoid such frauds. A bank fraud is a deliberate act of omission or commission by any person carried out in the course of banking transactions or in the books of accounts, resulting in wrongful gain to any person for a temporary period or otherwise, with or without any monetary loss to the bank. The relevant provisions of Indian Penal Code, Criminal Procedure Code, Indian Contract Act, and Negotiable Instruments Act relating to banking frauds has been cited in the present Article.

EVOLUTION OF BANKING SYSTEM IN INDIA

Banking system occupies an important place in a nation’s economy. A banking institution is indispensable in a modern society. It plays a pivotal role in economic development of a country and forms the core of the money market in an advanced country.

Banking industry in India has traversed a long way to assume its present stature. It has undergone a major structural transformation after the nationalization of 14 major commercial banks in 1969 and 6 more on 15 April 1980. The Indian banking system is unique and perhaps has no parallels in the banking history of any country in the world.

RESERVE BANK OF INDIA-ECONOMIC AND SOCIAL OBJECTIVE

The Reserve Bank of India has an important role to play in the maintenance of the exchange value of the rupee in view of the close interdependence of international trade and national economic growth and well being. This aspect is of the wider responsibly of the central bank for the maintenance of economic and financial stability. For this the bank is entrusted with the custody and the management of country’s international reserves; it acts also as the agent of the government in respect of India’s membership of the international monetary fund. With economic development the bank also performs a variety of developmental and promotional functions which in the past were registered being outside the normal purview of central banking. It also acts an important regulator.

BANK FRAUDS: CONCEPT AND DIMENSIONS

Banks are the engines that drive the operations in the financial sector, which is vital for the economy. With the nationalization of banks in 1969, they also have emerged as engines for social change. After Independence, the banks have passed through three stages. They have moved from the character based lending to ideology based lending to today competitiveness based lending in the context of India’s economic liberalization policies and the process of linking with the global economy.

While the operations of the bank have become increasingly significant banking frauds in banks are also increasing and fraudsters are becoming more and more sophisticated and ingenious. In a bid to keep pace with the changing times, the banking sector has diversified it business manifold. And the old philosophy of class banking has been replaced by mass banking. The challenge in management of social responsibility with economic viability has increased.

DEFINITION OF FRAUD

Fraud is defined as “any behavior by which one person intends to gain a dishonest advantage over another”. In other words , fraud is an act or omission which is intended to cause wrongful gain to one person and wrongful loss to the other, either by way of concealment of facts or otherwise.

Fraud is defined u/s 421 of the Indian Penal Code and u/s 17 of the Indian Contract Act. Thus essential elements of frauds are:

1. There must be a representation and assertion;

2. It must relate to a fact;

3. It must be with the knowledge that it is false or without belief in its truth; and

4. It must induce another to act upon the assertion in question or to do or not to do certain act.

BANK FRAUDS

Losses sustained by banks as a result of frauds exceed the losses due to robbery, dacoity, burglary and theft-all put together. Unauthorized credit facilities are extended for illegal gratification such as case credit allowed against pledge of goods, hypothecation of goods against bills or against book debts. Common modus operandi are, pledging of spurious goods, inletting the value of goods, hypothecating goods to more than one bank, fraudulent removal of goods with the knowledge and connivance of in negligence of bank staff, pledging of goods belonging to a third party. Goods hypothecated to a bank are found to contain obsolete stocks packed in between goods stocks and case of shortage in weight is not uncommon.

An analysis made of cases brings out broadly the under mentioned four major elements responsible for the commission of frauds in banks.

1. Active involvement of the staff-both supervisor and clerical either independent of external elements or in connivance with outsiders.

2. Failure on the part of the bank staff to follow meticulously laid down instructions and guidelines.

3. External elements perpetuating frauds on banks by forgeries or manipulations of cheques, drafts and other instruments.

4. There has been a growing collusion between business, top banks executives, civil servants and politicians in power to defraud the banks, by getting the rules bent, regulations flouted and banking norms thrown to the winds.

FRAUDS-PREVENTION AND DETECTION

A close study of any fraud in bank reveals many common basic features. There may have been negligence or dishonesty at some stage, on part of one or more of the bank employees. One of them may have colluded with the borrower. The bank official may have been putting up with the borrower’s sharp practices for a personal gain. The proper care which was expected of the staff, as custodians of banks interest may not have been taken. The bank’s rules and procedures laid down in the Manual instructions and the circulars may not have been observed or may have been deliberately ignored.

Bank frauds are the failure of the banker. It does not mean that the external frauds do not defraud banks. But if the banker is upright and knows his job, the task of defrauder will become extremely difficult, if not possible.

Detection of Frauds

Despite all care and vigilance there may still be some frauds, though their number, periodicity and intensity may be considerably reduced. The following procedure would be very helpful if taken into consideration:

1. All relevant data-papers, documents etc. Should be promptly collected. Original vouchers or other papers forming the basis of the investigation should be kept under lock and key.

2. All persons in the bank who may be knowing something about the time, place a modus operandi of the fraud should be examined and their statements should be recorded.

3. The probable order of events should thereafter be reconstructed by the officer, in his own mind.

4. It is advisable to keep the central office informed about the fraud and further developments in regard thereto.

Classification of Frauds and Action Required by Banks

The Reserve Bank of India had set-up a high level committee in 1992 which was headed by Mr. A… Ghosh, the then Dy. Governor Reserve Bank of India to inquire into various aspects relating to frauds malpractice in banks. The committee had noticed/observed three major causes for perpetration of fraud as given hereunder:

1. Laxity in observance of the laid down system and procedures by operational and supervising staff.

2. Over confidence reposed in the clients who indulged in breach of trust.

3. Unscrupulous clients by taking advantages of the laxity in observance of established, time tested safeguards also committed frauds.

In order to have uniformity in reporting cases of frauds, RBI considered the question of classification of bank frauds on the basis of the provisions of the IPC.

Given below are the Provisions and their Remedial measures that can be taken.

1. Cheating (Section 415, IPC)

Remedial Measures.

The preventive measures in respect of the cheating can be concentrated on cross-checking regarding identity, genuineness, verification of particulars, etc. in respect of various instruments as well as persons involved in encashment or dealing with the property of the bank.

2. Criminal misappropriation of property (Section 403 IPC).

Remedial Measure

Criminal misappropriation of property, presuppose the custody or control of funds or property, so subjected, with that of the person committing such frauds. Preventive measures, for this class of fraud should be taken at the level the custody or control of the funds or property of the bank generally vests. Such a measure should be sufficient, it is extended to these persons who are actually handling or having actual custody or control of the fund or movable properties of the bank.

3. Criminal breach of trust (Section 405, IPC)

Remedial Measure

Care should be taken from the initial step when a person comes to the bank. Care needs to be taken at the time of recruitment in bank as well.

4. Forgery (Section 463, IPC)

Remedial Measure

Both the prevention and detection of frauds through forgery are important for a bank. Forgery of signatures is the most frequent fraud in banking business. The bank should take special care when the instrument has been presented either bearer or order; in case a bank pays forged instrument he would be liable for the loss to the genuine costumer.

5. Falsification of accounts (Section 477A)

Remedial Measure

Proper diligence is required while filling of forms and accounts. The accounts should be rechecked on daily basis.

6. Theft (Section 378, IPC)

Remedial Measures

Encashment of stolen’ cheque can be prevented if the bank clearly specify the age, sex and two visible identify action marks on the body of the person traveler’s cheques on the back of the cheque leaf. This will help the paying bank to easily identify the cheque holder. Theft from lockers and safe deposit vaults are not easy to commit because the master-key remains with the banker and the individual key of the locker is handed over to the costumer with due acknowledgement.

7. Criminal conspiracy (Section 120 A, IPC)

In the case of State of Andhra Pradesh v. IBS Prasad Rao and Other, the accused, who were clerks in a cooperative Central Bank were all convicted of the offences of cheating under Section 420 read along with Section 120 A. all the four accused had conspired together to defraud the bank by making false demand drafts and receipt vouchers.

8. Offences relating to currency notes and banks notes (Section 489 A-489E, IPC)

These sections provide for the protection of currency-notes and bank notes from forgery. The offences under section are:

(a) Counterfeiting currency notes or banks.

(b) Selling, buying or using as genuine, forged or counterfeit currency notes or bank notes. Knowing the same to be forged or counterfeit.

(c) Possession of forged or counterfeit currency notes or bank-notes, knowing or counterfeit and intending to use the same as genuine.

(d) Making or passing instruments or materials for forging or counterfeiting currency notes or banks.

(e) Making or using documents resembling currency-notes or bank notes.

Most of the above provisions are Cognizable Offences under Section 2(c) of the Code of Criminal Procedure, 1973.

FRAUD PRONE AREAS IN DIFFERENT ACCOUNTS

The following are the potential fraud prone areas in Banking Sector. In addition to those areas I have also given kinds of fraud that are common in these areas.

Savings Bank Accounts

The following are some of the examples being played in respect of savings bank accounts:

(a) Cheques bearing the forged signatures of depositors may be presented and paid.

(b) Specimen signatures of the depositors may be changed, particularly after the death of depositors,

(c) Dormant accounts may be operated by dishonest persons with or without collusion of bank employees, and

(d) Unauthorized withdrawals from customer’s accounts by employee of the bank maintaining the savings ledger and later destruction of the recent vouchers by them.

Current Account Fraud

The following types are likely to be committed in case of current accounts.

(a) Opening of frauds in the names of limited companies or firms by unauthorized persons;

(b) Presentation and payment of cheques bearing forged signatures;

(c) Breach of trust by the employees of the companies or firms possessing cheque leaves duly signed by the authorized signatures;

(d) Fraudulent alteration of the amount of the cheques and getting it paid either at the counter or though another bank.

Frauds In Case Of Advances

Following types may be committed in respect of advances:

(a) Spurious gold ornaments may be pledged.

(b) Sub-standard goods may be pledged with the bank or their value may be shown at inflated figures.

(c) Same goods may be hypothecated in favour of different banks.

LEGAL REGIME TO CONTROL BANK FRAUDS

Frauds constitute white-collar crime, committed by unscrupulous persons deftly advantage of loopholes existing in systems/procedures. The ideal situation is one there is no fraud, but taking ground realities of the nation’s environment and human nature’s fragility, an institution should always like to keep the overreach of frauds at the minimum occurrence level.

Following are the relevant sections relating to Bank Frauds

Indian Penal Code (45 of 1860)

(a) Section 23 “Wrongful gain”.-

“Wrongful gain” is gain by unlawful means of property to which the person gaining is not legally entitled.

(b) “Wrongful loss”

“Wrongful loss” is the loss by unlawful means of property to which the person losing it is legally entitled.

(c) Gaining wrongfully.

Losing wrongfully-A person is said to gain wrongfully when such person retains wrongfully, as well as when such person acquires wrongfully. A person is said to lose wrongfully when such person is wrongfully kept out of any property, as well as when such person is wrongfully deprived of property.

(d) Section 24. “Dishonestly”

Whoever does anything with the intention of causing wrongful gain to one person or wrongful loss to another person, is said to do that thing “dishonestly”.

(e) Section 28. “Counterfeit”

A person is said to “counterfeit” who causes one thing to resemble another thing, intending by means of that resemblance to practice deception, or knowing it to be likely that deception will thereby be practiced.

BREACH OF TRUST

1. Section 408- Criminal breach of trust by clerk or servant.

2. Section 409- Criminal breach of trust by public servant, or by banker, merchant or agent.

3. Section 416- Cheating by personating

4. Section 419- Punishment for cheating by personation.

OFFENCES RELATING TO DOCMENTS

1) Section 463-Forgery

2) Section 464 -Making a false document

3) Section 465- Punishment for forgery.

4) Section 467- Forgery of valuable security, will, etc

5) Section 468- Forgery for purpose of cheating

6) Section 469- Forgery for purpose of harming reputation

7) Section 470- Forged document.

8) Section 471- Using as genuine a forged document

9) Section 477- Fraudulent cancellation, destruction, etc., of will, authority to adopt, or valuable security.

10) Section 477A- Falsification of accounts.

THE RESERVE BANK OF INDIA ACT, 1934

Issue of demand bills and notes Section 31.

Provides that only Bank and except provided by Central Government shall be authorized to draw, accept, make or issue any bill of exchange, hundi, promissory note or engagement for the payment of money payable to bearer on demand, or borrow, owe or take up any sum or sums of money on the bills, hundis or notes payable to bearer on demand of any such person

THE NEGOTIABLE INSTRUMENTS ACT, 1881

Holder’s right to duplicate of lost bill Section 45A.

1. The finder of lost bill or note acquires no title to it. The title remains with the true owner. He is entitled to recover from the true owner.

2. If the finder obtains payment on a lost bill or note in due course, the payee may be able to get a valid discharge for it. But the true owner can recover the money due on the instrument as damages from the finder.

Section 58

When an Instrument is obtained by unlawful means or for unlawful consideration no possessor or indorse who claims through the person who found or so obtained the instrument is entitled to receive the amount due thereon from such maker, acceptor or holder, or from any party prior to such holder, unless such possessor or indorse is, or some person through whom he claims was, a holder thereof in due course.

Section 85:

Cheque payable to order.

1. By this section, bankers are placed in privileged position. It provides that if an order cheque is indorsed by or on behalf of the payee, and the banker on whom it is drawn pays it in due course, the banker is discharged. He can debit his customer with the amount so paid, though the endorsement of the payee might turn out to be a forgery.

2. The claim protection under this section the banker has to prove that the payment was a payment in due course, in good faith and without negligence.

Section 87. Effect of material alteration

Under this section any alteration made without the consent of party would be void. Alteration would be valid only if is made with common intention of the party.

Section 138. Dishonour of cheque for insufficiency, etc., of funds in the account.

Where any cheque drawn by a person on an account maintained by him with a banker for payment of any amount of money to another person from out of that account for the discharge, in whole or in part, of any debt or other liability, is returned by the bank unpaid. either because of the amount of money standing to the credit of that account is insufficient to honour the cheque or that it exceeds the amount arranged to be paid from that account by an agreement made with that bank, such person shall be deemed to have committed an offence and shall, without prejudice.

Section 141(1) Offences by companies.

If the person committing an offence under Section 138 is a company, every person who, at the time the offence was committed, was in charge of, and was responsible to, the company for the conduct of the business of the company, as well as the company, shall be deemed to be guilty of the offence and shall be liable to be proceeded against and punished accordingly.

SECURITY REGIME IN BANKING SYSTEM

Security implies sense of safety and of freedom from danger or anxiety. When a banker takes a collateral security, say in the form of gold or a title deed, against the money lent by him, he has a sense of safety and of freedom from anxiety about the possible non-payment of the loan by the borrower. These should be communicated to all strata of the organization through appropriate means. Before staff managers should analyze current practices. Security procedure should be stated explicitly and agreed upon by each user in the specific environment. Such practices ensure information security and enhance availability. Bank security is essentially a defense against unforced attacks by thieves, dacoits and burglars.

PHYSICAL SECURITY MEASURES-CONCEPT

A large part of banks security depends on social security measures. Physical security measures can be defined as those specific and special protective or defensive measures adopted to deter, detect, delay, defend and defeat or to perform any one or more of these functions against culpable acts, both covert and covert and acclamations natural events. The protective or defensive, measures adopted involve construction, installation and deployment of structures, equipment and persons respectively.

The following are few guidelines to check malpractices:

1. To rotate the cash work within the staff.

2. One person should not continue on the same seat for more than two months.

3. Daybook should not be written by the Cashier where an other person is available to the job

4. No cash withdrawal should be allowed within passbook in case of withdrawal by pay order.

5. The branch manager should ensure that all staff members have recorder their presence in the attendance registrar, before starting work.

Execution of Documents

1. A bank officer must adopt a strict professional approach in the execution of documents. The ink and the pen used for the execution must be maintained uniformly.

2. Bank documents should not be typed on a typewriter for execution. These should be invariably handwritten for execution.

3. The execution should always be done in the presence of the officer responsible for obtain them,

4. The borrowers should be asked to sign in full signatures in same style throughout the documents.

5. Unless there is a specific requirement in the document, it should not be got attested or witnessed as such attestation may change the character of the instruments and the documents may subject to ad volrem stamp duty.

6. The paper on which the bank documents are made should be pilfer proof. It should be unique and available to the banks only.

7. The printing of the bank documents should have highly artistic intricate and complex graphics.

8. The documents executed between Banker and Borrowers must be kept in safe custody,

CHANGES IN LEGISLATIONS AFTER ELECTRONIC TRANSACTIONS

1. Section 91 of IPC shall be amended to include electronic documents also.

2. Section 92 of Indian Evidence Act, 1872 shall be amended to include commuter based communications

3. Section 93 of Bankers Book Evidence Act, 1891 has been amended to give legal sanctity for books of account maintained in the electronic form by the banks.

4. Section 94 of the Reserve Bank of India Act, 1939 shall be amended to facilitate electronic fund transfers between the financial institutions and the banks. A new clause (pp) has been inserted in Section 58(2).

RECENT TRENDS OF BANKING SYSTEM IN INDIA

In the banking and financial sectors, the introduction of electronic technology for transactions, settlement of accounts, book-keeping and all other related functions is now an imperative. Increasingly, whether we like it or not, all banking transactions are going to be electronic. The thrust is on commercially important centers, which account for 65 percent of banking business in terms of value. There are now a large number of fully computerized branches across the country.

A switchover from cash-based transactions to paper-based transactions is being accelerated. Magnetic Ink character recognition clearing of cheques is now operational in many cities, beside the four metro cities. In India, the design, management and regulation of electronically-based payments system are becoming the focus of policy deliberations. The imperatives of developing an effective, efficient and speedy payment and settlement systems are getting sharper with introduction of new instruments such as credit cards, telebanking, ATMs, retail Electronic Funds Transfer (EFT) and Electronic Clearing Services (ECS). We are moving towards smart cards, credit and financial Electronic Data Interchange (EDI) for straight through processing.

Financial Fraud (Investigation, Prosecution, Recovery and Restoration of property) Bill, 2001

Further the Financial Fraud (Investigation, Prosecution, Recovery and Restoration of property) Bill, 2001 was introduced in Parliament to curb the menace of Bank Fraud. The Act was to prohibit, control, investigate financial frauds; recover and restore properties subject to such fraud; prosecute for causing financial fraud and matters connected therewith or incidental thereto.

Under the said act the term Financial Fraud has been defined as under:

Section 512 – Financial Fraud

Financial frauds means and includes any of the following acts committed by a person or with his connivance, or by his agent, in his dealings with any bank or financial institution or any other entity holding public funds;

1. The suggestion, as a fact, of that which is not true, by one who does not believe it to be true;

2. The active concealment of a fact by one having knowledge or belief of the fact;

3. A promise made with out any intention of performing it;

4. Any other act fitted to deceive;

5. Any such act or omission as the law specially declares to be fraudulent.

Provided that whoever acquires, possesses or transfers any proceeds of financial fraud or enters into any transaction which is related to proceeds of fraud either directly or indirectly or conceals or aids in the concealment of the proceeds of financial fraud, commits financial fraud.

513(a) – Punishment for Financial Fraud

Whoever commits financial fraud shall be: (a) Punished with rigorous imprisonment for a term, which may extend to seven years and shall also be liable to fine.

(b)Whoever commits serious financial fraud shall be punished with rigorous imprisonment for a term which may extend to ten years but shall not be less than five years and shall also be liable for fine up to double the amount involved in such fraud.

Provided that in both (a) and (b) all funds, bank accounts and properties acquired using such funds subjected to the financial fraud as may reasonably be attributed by the investigating agency shall be recovered and restored to the rightful owner according to the procedure established by law.

CONCLUSION

The Indian Banking Industry has undergone tremendous growth since nationalization of 14 banks in the year 1969. There has an almost eight times increase in the bank branches from about 8000 during 1969 to mote than 60,000 belonging to 289 commercial banks, of which 66 banks are in private sector.

It was the result of two successive Committees on Computerization (Rangarajan Committee) that set the tone for computerization in India. While the first committee drew the blue print in 1983-84 for the mechanization and computerization in banking industry, the second committee set up in 1989 paved the way for integrated use of telecommunications and computers for applying technogical breakthroughs in banking sector.

However, with the spread of banking and banks, frauds have been on a constant increase. It could be a natural corollary to increase in the number of customers who are using banks these days. In the year 2000 alone we have lost Rs 673 crores in as many as 3,072 number of fraud cases. These are only reported figures. Though, this is 0.075% of Rs 8,96,696 crores of total deposits and 0.15% of Rs 4,44,125 crores of loans & advances, there are any numbers of cases that are not reported. There were nearly 65,800 bank branches of a total of 295 commercial banks in India as on June 30, 2001 reporting a total of nearly 3,072 bank fraud cases. This makes nearly 10.4 frauds per bank and roughly 0.47 frauds per branch.

An Expert Committee on Bank Frauds (Chairman: Dr.N.L.Mitra) submitted its Report to RBI in September 2001. The Committee examined and suggested both the preventive and curative aspects of bank frauds.

The important recommendations of the Committee include:

o A need for including financial fraud as a criminal offence;

o Amendments to the IPC by including a new chapter on financial fraud;

o Amendments to the Evidence Act to shift the burden of proof on the accused person;

o Special provision in the Cr. PC for properties involved in the Financial Fraud.

o Confiscating unlawful gains; and preventive measures including the development of Best Code Procedures by banks and financial institutions.

Thus it can be concluded that following measures should necessarily be adopted by the Ministry of Finance in order to reduce cases of Fraud.

o There must be a Special Court to try financial fraud cases of serious nature.

o The law should provide separate structural and recovery procedure. Every bank must have a domestic enquiry officer to enquire about the civil dimension of fraud.

o A fraud involving an amount of ten crore of rupees and above may be considered serious and be tried in the Special Court.

The Twenty-ninth Report of the Law Commission had dealt some categories of crimes one of which is “offences calculated to prevent and obstruct the economic development of the country and endanger its economic health.” Offences relating to Banking Fraud will fall under this category. The most important feature of such offences is that ordinarily they do not involve an individual direct victim. They are punishable because they harm the whole society. It is clear that money involved in Bank belongs to public. They deposit there whole life’ security in Banks and in case of Dacoity or Robbery in banks the public will be al lost. Thus it is important that sufficient efforts should be taken in this regard.

There exists a new kind of threat in cyber world. Writers are referring it as “Salami Attack” under this a special software is used for transferring the amount from the account of the individual. Hence the culprits of such crimes should be found quickly and should be given strict punishment. Moreover there is requirement of more number of IT professionals who will help in finding a solution against all these security threats.

Harness

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Gapcast #9 – Public Services

With Hans Rosling Public services (safe water, education, healthcare) meet basic human needs, but are currently unavailable to many people. Better information about access to these services is needed by service users and providers in order to make and measure progress in this area.

Medical Expense File Data Recovery Thai Cuisine

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Informing Long Term Care Choice – MDS 3.0 Section Q Training – Section Q Pilot Test Discussion

A discussion of the 5 State pilot test of MDS 3.0 Section Q. We would like to hear from you. Please send all comments to MDSforMedicaid@cms.hhs.gov. Thank you for your time.

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Disadvantages of Electronic Health Records System

Health Care Data

Electronic health record system is definitely a better way to do store patient’s medical health records. It allows for accurate record keeping, increased level of healthcare and a reduction in malpractice insurance premiums. It involves doing away with the pen and paper system of keeping medical records and embracing the digitalizing of all information. Like every new thing, change is not always welcome. A few physicians are stuck in their ways and are not embracing this new system without a fight.

The good news is that you can work around disadvantages to turn them into positive territory or find a replacement. Some of the disadvantages include:-

Privacy Protection

There will always been privacy issues in the healthcare system on who has access to your medical records. With a pen and paper system, with the physical file located at a particular institution there is a limit to who can see your records. Even if there was a security breach and your information is not secured, it is only available to people in that proximity.

But in a situation where your information is sent to a centralized information repository in digital format, all bets are off. This privacy concern is a big issue with many people and will continue to be an issue until it is addressed for good.

Medical records synchronization

Until recently with centralized information repositories, individuals being treated at different facilities could not have their information updated at the same time which could lead to healthcare providers not having updated information when they become available. However, with centralized repositories this problem has been solved, but it has given rise to the above mentioned issue of data security and protection.

High start up cost

There is a high start up cost when transforming a pen and paper system to EHR. Some physicians do not see any immediate benefit to their practice in the short run and drag their feet in implementing EHR.

Legal issues

Taking the healthcare industry to court has in the past few decades been a lucrative venture for attorneys trying to right the wrong done to a patient, whether by omission or commission.

Doctors are already practicing defensive medicine and electronic health record system brings a new potential avenue for litigation and revenue stream for lawyers. With a new system, anything can go wrong, the system could fail or the stored data stolen. Improper uses of collected information are all potential avenues for a law suit.

Gradually, electronic health record system is gaining traction. More and more doctors are embracing it, and depending on the part of the country you are looking at, conversion could be as high as 40%. With government involvement and the amount of resources it is investing, the time will come when digital medical record keeping will be the norm.

Bachelor Teaching Tummy Tuck

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NHIN Direct and CONNECT at the OSCON 2010 Healthcare Track

The Health IT track at OSCON this week brought together three of the thought leaders working to create a Nationwide Health Information Network (NHIN). They are: David Riley, head of the CONNECT initiative for the Federal Health Architecture (FHA) Program. Riley is responsible for creating the product direction and overseeing product development for CONNECT. Brian Behlendorf is a collaboration advisor for the CONNECT project, and he co-founded the Apache Web Server Project. Arien Malec is the coordinator for NHIN Direct, where he manages the activities of a public-private group that’s developing specifications for data transport in support of the meaningful use rules.

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Plasma Donations Put a Price on Human Life

Reminiscent of a medical facility, this plasma center, built only a year before is brimming with white lab coats, face shields and medical gloves. The sound of Velcro and beeps from blood pressure machines and the whirring of hematostats as they separate blood and plasma fill the air.

The appearance is all so sterile and clinical, but the workers here are not medically certified, they are only required to have a high school diploma and all are trained by each other. Of the almost 70 workers in this building, besides the LPN nurses and the one RN, certified phlebotomists (medically trained personnel that collect blood, plasma and tissue samples from patients) are 10 % of the workforce here which is a crapshoot for professionalism in the taking of blood and plasma.

As the donors (people who give a voluntary gift of plasma) are processed through, their vitals are taken and their appearance assessed as per the companies standard operating procedures (SOP). 38% of those interviewed come because they need the money to help pay for food, rent or bills, 60 % donate because the money supplemented their vacations or spending money, the other 2 % came because they believed that they were “Saving Lives.” Most are not your typical college students, but instead housewives, part-time workers or the working poor.

Plasmapherisis (the removal, treatment, and return of blood plasma from blood circulation) began back in the 1940’s in order to harvest clotting agents by the pharmaceutical companies – now there are more than 500 donation centers in the United States and more being built every day.

The buying and selling of Blood and Plasma is a multi-billion dollar per year business. Plasma is more commercial than Blood and can not be synthetically replicated. In 1988, more than 21 years ago, the industry made over 2 billion dollars per year alone making the current numbers staggering, but incredibly secret.

US Federal regulation is more liberal than anywhere else in the world allowing up to 60 liters (127 pints) a year. The next highest producing country is Canada allowing only 15 liters per year, which is the recommendation from the World Health Organization. More than half of the plasma used in medicines worldwide is from the US.

While US donors are the source of 60% of the world’s plasma, foreign companies like huge mosquitoes, are the ones that control the product from Japan, West Germany, Austria and Canada, flying in to the US to puncture the blood and plasma supply and then fly the profits home to feed on them. Not only do foreign companies own the majority of plasma collection centers, the majority of plasma medications are also sold abroad as well.

There are two different types of plasma donations…the first is non-profit. The largest would be The American Red Cross. According to FDA regulations, truly donated plasma and blood, without any funds exchanging hands between the donor and the organization, is the only blood or plasma that can be transfused into humans. If an individual is paid any money at all, for their time or for their plasma, it can not be used to “Save Lives” per se. Because for-profit donation centers feed on the need or the greed of the economic world temperature, non-profit donation centers are suffering. When non-profit donation centers suffer, then those who need plasma: burn, shock or trauma victims go without. Those looking to make a humanitarian donations should be donating blood and plasma at non-profit donation centers like the American Red Cross.

Donations that are “paid” for are sold to drug and research companies and with the economic downturn of 2007-2009, plasma donation centers are on the rise with one of the largest Austrian Pharmaceutical backed donation centers achieving a 19% rise in stock prices within a quarter while other markets were plummeting.

The ethical question of Plasma Donation comes at a cost. Organ donation is not an unusual thing, but bodily “donation” that is suppose to help and not hinder human survival is questionable when big business gets involved, and for-profit donation of blood and plasma is very big business.

Plasma that is donated to drug and research companies is refined down and made into medicines that “Save Lives”. What is the cost of those medicines to those that would die without them? $50,000.00 to $80,000.00 per year, which can really change the slogan, “We Save Lives” to “We Cant Afford to Live”. Those without insurance or government funded backing can not afford the medications or treatments and without those “donated” treatments, die. Most are government funded solutions, which means tax payers, donors or non-donors, are paying to treat those that would die without the treatments that are suppose to be a voluntary gift…so the saying, “Give until it hurts” may be more applicable.

For-profit donation centers started targeting college students in the 1970’s to improve the quality of the plasma supply. Companies speculated that college students should be healthier than the average population. In 1999 a study was conducted by Ohio University which found that university plasma donors were not as healthy as once thought. Paid donors are three times more likely than non-donors and four times more likely then Red Cross donors to drink alcohol five or more times a week. One eighth of non-donors, one quarter of Red Cross Donors to one third of paid donors smoke tobacco. Consumption of toxins or unhealthy lifestyle is not the only issue at hand today, body piercings, tattoos and branding are other issues that pose unhealthy donation bases as well. Body art is not always visible and unless confessed to, can not always be subject to scrutiny by the donation center.

For profit donation centers will pay $8.00 -$20.00 dollars for the first donation and then to encourage the donor to come back, will pay a higher price for the second donation within the seven day period.

Depending on the weight of the individual, the donation center will take 690mL to 880mL per donation. The 880mL bottles bring a price of anywhere from $300.00 to $1,700.00 when sold to the Pharmaceutical companies. If there is anything wrong with the plasma, if it’s hemolysised (infused with red blood cells) or if the plasma is lipemic (excess fat within the plasma) the plasma is sold to veterinarian companies and bring a lesser price for the donation center.

Plasma donation was worth approximately 4.5 billion dollars in 2007. Today there are approximately 1.5 to 2 million donors worldwide and is expected to grow significantly in the struggling economy of 2009.

Because of the rapid growth within the industry, corporations train their workforce to take the donations, paying an average of $10.00 per hour. The workforce usually does not have medical certification or medical training unless they are one of the 8 LPN’s or RN’s that are hired. A licensed medical doctor covers the center with his license, but he is rarely seen on the floor of the center. He comes in maybe once a week to sign charts and watch vitals being taken once on those being trained and then he is off again, taking only his cut of the centers profits. The corporate training is not done by the LPN’s or RN or even by the doctor, it is done by regular employees that do not have medical certification or license.

Corporate training consists of reading of Standard Operating Procedures in a conference room for several hours, sometimes days, then you are put out on the floor with a trainer to watch him/her go through the motions. If you have an efficient trainer, then you can process with professionalism, but if you do not, then most Medical Historians (Someone who takes vitals, transcribed medical information and does basic phlebotomy) struggle and their bedside manner, technique and record keeping will leave much to be desired and the donors do not get the care that they may need.

In this center, processing time is a task master. This center processed 570 donors in one day with an average of 390 customers a day. From the time donors check in with the receptionist until they scan out they are timed. Time is money in this industry. When doing vitals, the Medical Historians are given a maximum of 1 minute 21 seconds to complete the processing of the donor and sending them out to the phlebotomy floor for the donation which is not much time to practice accuracy. There is no time to check your gloves for contamination issues such as plasma, mucus or blood, so donors are subject to cross-contamination every time they come into the center. Company policy states that gloves should only be changed when they are contaminated with blood, torn, cut or every two and one-half hours.

That is to save time between donors and the crack of the whip comes from the managers as they wait with stop-watches and pink slips over their white coated slave labor force. The Medical Historians are moving so fast in order to keep from getting fired that there were 2 contaminations of workers within 2 months…both from filled but broken capillary tubes that were shoved into the workers skin through their gloves or through their lab coats and scrubs and into their skin. One contamination happened when a Medical Historian tried to pull a hair out of her mouth and realized that she had just consumed the previous donors blood. Donors have to ask specifically to have the Medical Historians “change your gloves” before they are allowed to do it.

Phlebotomists on the floor are moving just as fast. They have one minute to clean, find the vein and stick the donor. They can stick 3 times, twice per arm unless there is a loss of red blood cells or the donor is in danger and needing saline, then they can stick the third time for emergencies. This causes the likelihood of Hematomas (Blood that collects under the skin or in an organ) for the donors, large bruises over 3 inches and tender areas on the arm. Sometimes, because a donor has to be stuck twice, both arms result in hematomas. Donors have to heal up for several weeks before they can return to donate, which makes the donation process an unreliable source of income for anyone.

When this center is running at full gear, processing 570 donors per day, most who work an 8 hour shift are not allowed to take lunches and sometimes not allow to take bathroom breaks. The pace is fast and furious and as soon as the donors are processed and the plasma is back in the lab, they tear down the used sets and get ready for the next donor. Used sets can be dangerous, they are suppose to be heat sealed but sometimes if there is equipment failure, the tubing doesn’t get sealed completely and when the phlebotomist pulls the tubes off the machines, plasma can splash up and out into the face, unprotected arms and saturate clothing. The Personal Protective Equipment required by OSHA doesn’t always cover everything it needs to cover, especially since Personal Protective Equipment is not fitted or trained on, so the workers are in constant hazard of contamination, which happened at least once within a 3 month period of time in this center. There are not only hazards to the Employees, but to the donors as well in this atmosphere. Because the center is trying to fill beds as soon as possible, sometimes beds are not cleaned before the donors sit down and donors can find themselves sitting in the blood of the last donor.

There are 22 Right-to-Work states in the US, which means that in order to receive lunch and bathroom breaks, they have to be contractual or within Union Guidelines, if they are not, the Department of Labor can not enforce bathroom breaks or Lunches for the workers. Of the 22 Right-to-Work states, plasma centers flood at least 13 of those states, and build fewer plasma centers in non-right to work states.

Employees have a hard 8 to 10 hour shift in front of them, not only working long hours without breaks, but working in a precise and fast paced environment as well and without the certified medical training that is desired.

Because they do not have the training and because the bottom line pushes ethics, sometimes shortcuts are taken. When the plasma is delivered to the lab, the lab tech has only 30 minutes to process all those bottles. If the bottle is leaking, that bottle has to be thrown out because it is air contaminated, if the bottles take longer then 30 minutes to process before being put in the storage freezer, they are thrown out, a loss of a lot of money. What has happened in the past is that the lab tech will push the bottles back over into more time to process, or the lab tech will process an air contaminated bottle and just wipe it down, or instead of taking samples from each of the plasma bottles as required by FDA, they will open one bottle and take all the samples from that one bottle…because it saves time. These infractions can close a center, but only if it is caught and reported to the FDA, which questions the purity and usability of the plasma in the system and poses the question of contamination of medications as well.

Workers who stay in this business have after 3 months suffer from foot problems, back problems, hip problems, headaches, varicose veins and neck problems that are not covered by Workman’s Comp and the conditions are not covered by OSHA. This doesn’t include the possibility of contamination that may render them with HIV, Hepatitis or other communicable diseases. These are long lasting ailments and conditions with long lasting effects. Although there are only a few that stay in this field longer than 6 months, Supervisory positions are no better.

Supervisors have demanding jobs as well. They oversee the operations to maintain not only FDA standards but also the Company’s SOP (Standard Operating Procedures). Supervisors not only man the course of Medical Historians, but also phlebotomists on the floor and incoming data entry. A supervisor must be trained and tested on all aspects of phlebotomy and medical history as well as incoming data. If the Medical Historians and Phlebotomy work 8 to 10 hour shifts without lunch or bathroom breaks, then the supervisor works 12 hour shifts with the same conditions and with the added responsibility of catching all non-conforming events that may give the center a Quality Incident Report that, depending on the severity, may be reported to the FDA if it effects the health of the public.

When new donors come through the door, they are required to read a “New Donor” booklet, which has in it all the side effects, what to expect and some of the documentation that they will be required to sign. From the time they check in until they are done reading the book, even the donors are timed, up to 10 minutes to read their packet of legal documents. After they are done reading, they are asked for two forms of identification, usually a current driver’s license and social security card will be sufficient. If the driver’s license is not current or an address is not current, then a piece of mail that is dated less than 60 days can be used to verify the address. Social Security must be verified by Social Security Card, current Tax Information or Pay stub.

Plasma donors are usually not aware of side effects and most likely told that plasma donations are safe in the long term…the reality is that 7% of the human population has an anaphylactic reaction to sodium citrate or saline of which they will need intravenous medications immediately. If they do not receive treatment within minutes, the reaction is fatal.

In this center, we have at least 5 to 6 lesser reactions a day, sometimes more. Immediate side effects can be fainting, bleeding, edema at the venipuncture site, nausea, vomiting, drop in blood pressure, faintness, dizziness, blurred vision, coldness, sweating or abdominal cramps.

If allowed to progress the side effects can be tingling around the mouth or in the limbs, muscle cramps, metallic taste in the mouth and further reactions can lead to irregular heartbeat or seizures.

After prolonged donations, 12% of donors will have a lowered level of antibodies, causing an inadequate immune system response and the probability of increased infection or disease for the rest of their lives.

Plasma donations can save lives, especially when given freely and as a humanitarian gesture…drug and research companies would like the public to believe that they are the good guys in order to increase the bottom line in this Multi-billion dollar business, profiting on the generosity of some and the desperation and greed of others, treating donors like Cash Cows grazing on the bottom line.

For-profit donations feed a fire-storm of ethical questions such as, “if selling human organs is immoral, unethical and illegal, then what makes selling Plasma any different?” “If harvesting a human organ and holding it ransom to those that can pay the price to live, if selling it to the highest bidder is wrong, then isn’t harvesting plasma and selling it to those that would die without it the same thing?” What is the cost of a human life? With 15 million donations a year, the plasma industry looks the donor gift horse in the mouth everyday and laughs all the way to the bank. For-Profit plasma companies have a win-win situation…donors give their plasma or practically give their plasma to the industry and the blood sucking, plasma hoarding corporations can turn around and charge $50,000.00 to $80,000.00 a year to allow a person to live, long term cost projections are at $3.7 million to $5.9 million for medications that allow one person to live a normal life…and now we can put a price on what a human life is worth to the plasma industry.

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