Auditing Firm is Accused of Negligence Following Health Insurance Company Bankruptcy

    Joseph O'Neill

    Written by
    — Updated on December 22, 2017

    Auditing Expert WitnessThis is a professional negligence case against a large auditing firm. The defendant firm was performing the audits for a regional medical insurance firm in southern Texas. According to the relevant laws, insurance companies are required to maintain a certain amount of liquidity. It was alleged that the auditing firm was approving transactions off of the balance sheet that made non-cash assets look like cash. As a result of this, an eventual investigation into the insurance company’s financials led the firm, which had 50,000+ members, to fold within a month.

    Question(s) For Expert Witness

    • 1. How long have you worked in the accounting audit industry, and in what capacity?
    • 2. What experience do you have with statutory accounting principles as they relate to insurance company accounting?
    • 3. Is it below the standard of care for an auditor to allow off-balance sheet, non-cash transactions that lead to a violation of solvency rules, as described in this case?

    Expert Witness Response E-110899

    I am a licensed CPA in the states of Florida, New York, Colorado and Maryland. I  have performed services worldwide. I have been practicing as a Partner in small- to medium-sized CPA firms since 1986, primarily in the “attest” areas with minor involvement in tax preparation and review. Additionally, I have expertise in the insurance industry from the “audit” side, and I spent approximately 12 years in high level finance positions with insurance companies in the life, P&C, and healthcare industries. I have been the Audit Partner responsible for all audit work for 3 CPA firms dating back to the mid-1980’s. I have audited more than 20 insurance companies and have performed several healthcare engagements, including audits. I have taught hundreds of seminars on SAP, as well as each and every component of a SAP Annual Statement and the comparisons if SAP GAAP. I have worked with actuaries, reinsurance carriers, and intermediaries on reinsurance transactions and their treatments in both SAP and GAAP financial statements as well as for tax return purposes. In addition, I have assisted in identifying potentially insolvent Insurance carriers and then testified as an expert in bringing those carriers into the rehabilitation and liquidation division of the DFS. I have also opposed the Division of Rehabilitation and Liquidation in filing claims and securing more than $20 million of shareholder funds from the DFS. It is most definitely below the standard of care for an auditor to allow such off-balance sheet transactions without any disclosure regardless of solvency, but certainly when the situation results in a solvency issue.

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