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FRAUD EXAMINERS MANUAL

2013 Fraud Examiners Manual i

TABLE OF CONTENTS

VOLUME I

SECTION 1

FINANCIAL TRANSACTIONS AND FRAUD SCHEMES

ACCOUNTING CONCEPTS

Accounting Basics ........................................................................................................................ 1.101

Financial Statements .................................................................................................................... 1.105

Generally Accepted Accounting Principles (GAAP) .............................................................. 1.115

FINANCIAL STATEMENT FRAUD

What Is Financial Statement Fraud?.......................................................................................... 1.203

The Cost of Financial Statement Fraud .................................................................................... 1.203Why Financial Statement Fraud Is Committed ....................................................................... 1.204

Trends in Financial Statement Fraud ........................................................................................ 1.205

Financial Statement Fraud Schemes .......................................................................................... 1.209

What Red Flags Are Associated with Financial Statement Fraud Generally? ..................... 1.238

Detection of Fraudulent Financial Statement Schemes ......................................................... 1.239

Financial Statement Analysis ...................................................................................................... 1.241

Interviews in Fraudulent Financial Statement Cases .............................................................. 1.248

Prevention of Financial Statement Fraud ................................................................................. 1.256

ASSET MISAPPROPRIATION: CASH RECEIPTSSkimming ....................................................................................................................................... 1.301

Cash Larceny ................................................................................................................................. 1.319

ASSET MISAPPROPRIATION: FRAUDULENT DISBURSEMENTS

Register Disbursement Schemes ................................................................................................ 1.401

Check Tampering ......................................................................................................................... 1.409

Billing Schemes ............................................................................................................................. 1.436

Payroll Fraud ................................................................................................................................. 1.455

Expense Reimbursement Schemes ............................................................................................ 1.472

ASSET MISAPPROPRIATION: INVENTORY AND OTHER ASSETS

Misuse of Inventory and Other Assets ..................................................................................... 1.501

Theft of Inventory and Other Assets........................................................................................ 1.502

Misappropriation of Intangible Assets ...................................................................................... 1.517


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BRIBERY AND CORRUPTION

Corruption ..................................................................................................................................... 1.601

Procurement Fraud ...................................................................................................................... 1.611Detection of Bribery Schemes ................................................................................................... 1.622

Conflicts of Interest ..................................................................................................................... 1.636

THEFT OF INTELLECTUAL PROPERTY

Competitive Intelligence (CI) Versus Espionage .................................................................... 1.702

Open Sources of Information .................................................................................................... 1.703

The Intelligence Pyramid ............................................................................................................ 1.706

Building Financial Statements .................................................................................................... 1.712

Nontraditional Sources ................................................................................................................ 1.715

A Closer Look at Databases ....................................................................................................... 1.717A Corporate Spy Uses Open Sources: What of It? ................................................................. 1.719

Favorite Targets ............................................................................................................................ 1.721

How Information Is Lost ........................................................................................................... 1.722

Basic Principle of Spying ............................................................................................................. 1.727

Infilitration Techniques ............................................................................................................... 1.734

Transactional Intelligence ........................................................................................................... 1.741

Telling Good Lies ........................................................................................................................ 1.743

Visual Surveillance Against People ............................................................................................ 1.745

Email .............................................................................................................................................. 1.746

Social Engineering ........................................................................................................................ 1.747Cloaking and Misdirection .......................................................................................................... 1.750

Technical Surveillance ................................................................................................................. 1.761

Investigating an Information Theft Case ................................................................................. 1.776

Program for Safeguarding Proprietary Information ............................................................... 1.778

Technical Surveillance Countermeasures Survey .................................................................... 1.787

Preventing Employee Theft of Propietary Information ........................................................ 1.788

Protecting the Trade Secrets of Others .................................................................................... 1.791

Legal Issues Related to Theft of Intellectual Property ........................................................... 1.792

FINANCIAL INSTITUTION FRAUDEmbezzlement Schemes ............................................................................................................. 1.801

Loan Fraud .................................................................................................................................... 1.803

Real Estate Fraud ......................................................................................................................... 1.812

Mortgage Fraud ............................................................................................................................ 1.819

New Account Fraud Schemes .................................................................................................... 1.831


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FINANCIAL INSTITUTION FRAUD (CONT.)

Money Transfer (Wire) Fraud Schemes .................................................................................... 1.834

Automated Teller Machine (ATM) Fraud ................................................................................ 1.837Advance Fee Fraud ...................................................................................................................... 1.838

Letter-of-Credit Fraud ................................................................................................................. 1.839

Inside/Outside Frauds ................................................................................................................ 1.839

Prevention ..................................................................................................................................... 1.840

Suspicious Activity Reports ........................................................................................................ 1.842

Dodd-Frank Wall Street Reform and Consumer Protection Act ......................................... 1.843

Applicable Federal Statutes ......................................................................................................... 1.844

CHECK AND CREDIT CARD FRAUD

Check Fraud .................................................................................................................................. 1.901Credit Card Fraud ........................................................................................................................ 1.913

Prevention and Detection of Credit Card Fraud ..................................................................... 1.923

Electronic Bill Payment and Person-to Person Payments ..................................................... 1.934

INSURANCE FRAUD

Types of Insurance Policies ........................................................................................................ 1.1001

Agent/Broker Fraud .................................................................................................................... 1.1002

Underwriting Irregularities .......................................................................................................... 1.1003

Vehicle Insurance Schemes ........................................................................................................ 1.1005

Property Schemes ......................................................................................................................... 1.1008Life Insurance Schemes............................................................................................................... 1.1008

Liability Schemes .......................................................................................................................... 1.1009

Red Flags of Insurance Fraud................................................................................................ 1.1009

Computer-Generated Detection Reports ................................................................................. 1.1013

Workers Compensation Fraud.................................................................................................. 1.1014

HEALTH CARE FRAUD

Laws Relating to Health Care Fraud ......................................................................................... 1.1101

Fraud by the Insurance Company ............................................................................................. 1.1113

Employee Claims Fraud .............................................................................................................. 1.1115Agent Fraud .................................................................................................................................. 1.1116

Provider Fraud .............................................................................................................................. 1.1118

Fraud by the Medical Staff .......................................................................................................... 1.1127

Kickbacks in the Health Care Industry ..................................................................................... 1.1127

Inflated Billings ............................................................................................................................. 1.1128

Insured Fraud ............................................................................................................................... 1.1132


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HEALTH CARE FRAUD (CONT.)

Criminal Rings .............................................................................................................................. 1.1133

Collusion ........................................................................................................................................ 1.1133Detection of External Fraud ...................................................................................................... 1.1134

Fraud by Medical Institutions .................................................................................................... 1.1135

Nursing Homes ............................................................................................................................ 1.1142

Psychiatric Hospital Fraud .......................................................................................................... 1.1143

Other Frauds in the Institutional Setting .................................................................................. 1.1145

Managed Care ............................................................................................................................... 1.1146

Medicaid Fraud ............................................................................................................................. 1.1148

Electronic Claims Fraud.............................................................................................................. 1.1152

Health Care Compliance Programs ........................................................................................... 1.1155

BANKRUPTCY FRAUD

Introduction .................................................................................................................................. 1.1201

The Bankruptcy Code.................................................................................................................. 1.1204

Creditors Rights and Remedies................................................................................................. 1.1211

Bankruptcy Crime Statutes ......................................................................................................... 1.1214

Bankruptcy Schemes .................................................................................................................... 1.1221

TAX FRAUD

Introduction .................................................................................................................................. 1.1301

Hallmarks (Badges) of Fraud ...................................................................................................... 1.1302Civil Versus Criminal ................................................................................................................... 1.1304

Taxpayer Penalties........................................................................................................................ 1.1304

Tax Preparer Penalties ................................................................................................................. 1.1307

Whistleblower Programs ............................................................................................................. 1.1309

Defenses for Tax Fraud .............................................................................................................. 1.1309

Evidence of Tax Fraud ................................................................................................................ 1.1311

Other Legal Elements of Tax Fraud ......................................................................................... 1.1312

SECURITIES FRAUD

Introduction .................................................................................................................................. 1.1401Federal Regulation ....................................................................................................................... 1.1401

Self-Regulatory Organizations .................................................................................................... 1.1416

State Regulation ............................................................................................................................ 1.1417

What Constitutes a Security? ...................................................................................................... 1.1419

Commodity Futures, Exchange-Traded Options, and OTC Options ................................. 1.1432

Securities Fraud Schemes ............................................................................................................ 1.1438


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SECURITIES FRAUD (CONT.)

Investigative Tips ......................................................................................................................... 1.1458

Securities Fraud and the Internet ............................................................................................... 1.1461

MONEY LAUNDERING

Introduction .................................................................................................................................. 1.1501

The Money Laundering Process ................................................................................................ 1.1501

Alternative Remittance Systems ................................................................................................. 1.1518

Federal and State Law.................................................................................................................. 1.1520

International Anti-Money Laundering Efforts ........................................................................ 1.1544

Enforcement and Prevention Strategies ................................................................................... 1.1548

Special Problems for Insurance Companies ............................................................................ 1.1551

CONSUMER FRAUD

Con Schemes ................................................................................................................................ 1.1602

Telemarketing Fraud .................................................................................................................... 1.1608

Ponzi and Pyramid Schemes ...................................................................................................... 1.1629

Franchise Fraud ............................................................................................................................ 1.1649

Identity Theft ................................................................................................................................ 1.1655

COMPUTER AND INTERNET FRAUD

Computer Fraud Versus Computer Crime ............................................................................... 1.1703

Computer Hacking ....................................................................................................................... 1.1705Malware ......................................................................................................................................... 1.1721

Electronic Mail ............................................................................................................................. 1.1732

Internet Fraud ............................................................................................................................... 1.1735

Electronic Commerce .................................................................................................................. 1.1746

Insider Threats .............................................................................................................................. 1.1751

Computer Security ....................................................................................................................... 1.1752

Conducting an Investigation Regarding Computer Crimes ................................................... 1.1766

Handling Digital Evidence .......................................................................................................... 1.1769

Computer Crime Laws ................................................................................................................ 1.1783

Government Information on Cybercrime ................................................................................ 1.1794

PUBLIC SECTOR FRAUD

Government Fraud Auditing Standards ................................................................................... 1.1801

False Claims and Statements ...................................................................................................... 1.1812

Beneficiary Fraud ......................................................................................................................... 1.1816

Government Initiatives to Reduce Fraud ................................................................................. 1.1819


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PUBLIC SECTOR FRAUD (CONT.)

Interviewing Government Officials .......................................................................................... 1.1824

CONTRACT AND PROCUREMENT FRAUD

Elements of a Contract ............................................................................................................... 1.1901

Phases of the Contracting Process ............................................................................................ 1.1901

Using Computers to Combat Procurement Fraud .................................................................. 1.1914


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2013 Fraud Examiners Manual vii

VOLUME II

SECTION 2LAW

OVERVIEW OF THE UNITED STATES LEGAL SYSTEM

Basic Concepts of the Law ......................................................................................................... 2.101

The Court System ........................................................................................................................ 2.104

Civil and Criminal Actions for Fraud ........................................................................................ 2.110

THE LAW RELATED TO FRAUD (PART 1)

Definition of Fraud ...................................................................................................................... 2.201

Principal Types of Fraud ............................................................................................................. 2.201

Federal Legislation Related to Fraud......................................................................................... 2.215

THE LAW RELATED TO FRAUD (PART 2)

Federal Legislation Related to Fraud (Cont.) ........................................................................... 2.301

Fines Under Title 18 .................................................................................................................... 2.343

Qui Tam Suits and the Civil False Claims Act ......................................................................... 2.347

Federal Whistleblower Statutes.............................................................................................. 2.351

The United Kingdom Bribery Act ............................................................................................. 2.362

INDIVIDUAL RIGHTS DURING EXAMINATIONS

Employees Duty to Cooperate.................................................................................................. 2.401Employees Rights During the Investigation ........................................................................... 2.402

Interviews ...................................................................................................................................... 2.406

Searches and Surveillance............................................................................................................ 2.418

Polygraph Examinations ............................................................................................................. 2.442

Obtaining Information About Employees ............................................................................... 2.443

Avoiding Liability for Obstruction of Justice and Witness Tampering ............................... 2.450

Discharging a Suspected Wrongdoer ........................................................................................ 2.454

CRIMINAL PROSECUTIONS FOR FRAUD

Basic Principles of Criminal Law ............................................................................................... 2.501Constitutional Rights ................................................................................................................... 2.501

Arrests ............................................................................................................................................ 2.503

Interrogation of Suspects ............................................................................................................ 2.504

The Charging Process .................................................................................................................. 2.506

The Trial Process ......................................................................................................................... 2.519

Sentencing ..................................................................................................................................... 2.528

Appeal ............................................................................................................................................ 2.538


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LAW

THE CIVIL JUSTICE SYSTEM

Civil Litigation .............................................................................................................................. 2.601

Alternative Dispute Resolution .................................................................................................. 2.616Trial of a Civil Case ...................................................................................................................... 2.616

Fidelity Bond Claims ................................................................................................................... 2.619

BASIC PRINCIPLES OF EVIDENCE

Definition of Evidence ................................................................................................................ 2.701

Three Basic Forms of Evidence ................................................................................................ 2.701

Direct Versus Circumstantial Evidence .................................................................................... 2.702

Admissability of Evidence .......................................................................................................... 2.703

Special Rules Concerning Some Types of Circumstantial Evidence .................................... 2.704

Exhibits .......................................................................................................................................... 2.707Hearsay .......................................................................................................................................... 2.717

Excluding Illegally Seized Evidence .......................................................................................... 2.723

Impeachment ................................................................................................................................ 2.724

Privileges ........................................................................................................................................ 2.725

TESTIFYING AS AN EXPERT WITNESS

Introduction .................................................................................................................................. 2.801

Pre-Trial Preparation ................................................................................................................... 2.803

Conflicts of Interest ..................................................................................................................... 2.803

Preparing a Report ....................................................................................................................... 2.804Qualifying to Testify as an Expert Witness .............................................................................. 2.809

Preparing to Testify ..................................................................................................................... 2.814

Direct Examination ..................................................................................................................... 2.818

Cross-Examination ...................................................................................................................... 2.820

Expressing an Opinion on Guilt................................................................................................ 2.826

Witness Immunity for Experts ................................................................................................... 2.827

Summary ........................................................................................................................................ 2.828


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SECTION 3INVESTIGATION

ANALYZING DOCUMENTS

Obtaining Documentary Evidence ............................................................................................ 3.101

Examining Fraudulent Documents ........................................................................................... 3.104

Handling Documents as Physical Evidence ............................................................................. 3.105

Identifying Writings ..................................................................................................................... 3.109

The Document Experts Findings............................................................................................. 3.111

How to Obtain Handwriting Samples ...................................................................................... 3.112

Typewriters and Computer Printers .......................................................................................... 3.115

Photocopies .................................................................................................................................. 3.116

Dating a Document ..................................................................................................................... 3.118

Indented Writings ........................................................................................................................ 3.120

Counterfeit Printed Documents ................................................................................................ 3.121

Fingerprints ................................................................................................................................... 3.122Sources for Expert Document Examinations.......................................................................... 3.124

INTERVIEW THEORY AND APPLICATION

Preparation .................................................................................................................................... 3.201

Characteristics of a Good Interview ......................................................................................... 3.201

Characteristics of a Good Interviewer ...................................................................................... 3.202

Question Typology ...................................................................................................................... 3.203

Legal Considerations When Conducting an Interview ........................................................... 3.204

Elements of Conversations......................................................................................................... 3.206

Inhibitors of Communication .................................................................................................... 3.207

Facilitators of Communication .................................................................................................. 3.210

Interview Mechanics .................................................................................................................... 3.212

Introductory Questions ............................................................................................................... 3.214

Informational Questions ............................................................................................................. 3.223

Closing Questions ........................................................................................................................ 3.235

Assessment Questions ................................................................................................................. 3.238

Admission-Seeking Questions.................................................................................................... 3.250

Kinesic Interview and Interrogation ......................................................................................... 3.275

Criteria-Based Statement Analysis ............................................................................................. 3.278

The Cognitive Interview Technique .......................................................................................... 3.283


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INVESTIGATION

COVERT EXAMINATIONS

Establishing an Identity ............................................................................................................... 3.302

Objectives ...................................................................................................................................... 3.303Problems in Covert Operations ................................................................................................. 3.304

Entrapment ................................................................................................................................... 3.305

Surveillance ................................................................................................................................... 3.305

Sources and Informants .............................................................................................................. 3.313

Use of Operatives ........................................................................................................................ 3.322

SOURCES OF INFORMATION

Public Versus Non-Public Records ........................................................................................... 3.402

Laws Governing Access to Information .................................................................................. 3.404

City Government Records .......................................................................................................... 3.412County Government Records .................................................................................................... 3.414

State Government Records ........................................................................................................ 3.421

Federal Government Records .................................................................................................... 3.429

Non-Public Records .................................................................................................................... 3.451

Commercial Sources of Information ........................................................................................ 3.455

Public Record Database Vendors .............................................................................................. 3.458

Directories ..................................................................................................................................... 3.460

Banks and Financial Institutions ................................................................................................ 3.474

Investigative and Law Enforcement Information Centers and Databases ......................... 3.479

ACCESSING INFORMATION ONLINE

Investigating with the Internet ................................................................................................... 3.501

A Guide to Successful Internet Searching ................................................................................ 3.511

Online Public Database Searches .............................................................................................. 3.515

Useful Websites ............................................................................................................................ 3.532

DATA ANALYSIS AND REPORTING TOOLS

Data Mining .................................................................................................................................. 3.601

Using Data Analysis Software .................................................................................................... 3.604

Types of Data Mining and Analysis Software .......................................................................... 3.626Reporting and Case Management Software ............................................................................. 3.642


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INVESTIGATION

DIGITAL FORENSICS

Conducting an Investigation Involving Computers ................................................................ 3.701

Computer Investigations and Computer Forensics ................................................................ 3.709Forensic Examination and Analysis .......................................................................................... 3.723

Digital Forensics Software .......................................................................................................... 3.729

TRACING ILLICIT TRANSACTIONS

Interviews ...................................................................................................................................... 3.801

Direct Methods of Tracing Financial Transactions ................................................................ 3.805

Indirect Methods of Tracing Financial Transactions .............................................................. 3.832

Locating Hidden Assets .............................................................................................................. 3.850

REPORTING STANDARDSPreparation .................................................................................................................................... 3.901

Characteristics of a Good Report .............................................................................................. 3.901

Common Reporting Mistakes .................................................................................................... 3.903

Methods for Taking Effective Notes ........................................................................................ 3.905

Organization of Information ...................................................................................................... 3.906

Analyzing the Reader ................................................................................................................... 3.907

Presenting the Case to Prosecutors ........................................................................................... 3.908

Outlining........................................................................................................................................ 3.910

Grammatical Considerations ...................................................................................................... 3.911

Report Structure ........................................................................................................................... 3.915Signed Statements ........................................................................................................................ 3.922

Visual Aids .................................................................................................................................... 3.925

Engagement Contracts ................................................................................................................ 3.931

Fraud Examination Checklist ..................................................................................................... 3.935


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SECTION 4FRAUD PREVENTION AND DETERRENCE

UNDERSTANDING HUMAN BEHAVIOR

Behavioral Analysis and the Detection of Fraud ..................................................................... 4.101

Why People Obey the Law ......................................................................................................... 4.107

THEORIES OF CRIME CAUSATION

Classical Criminology .................................................................................................................. 4.201

Routine Activities Theory ........................................................................................................... 4.202

Biological Theories ...................................................................................................................... 4.203

Pyschological Theories ................................................................................................................ 4.203

Social Structure Theories ............................................................................................................ 4.204

Social Process Theories ............................................................................................................... 4.205

WHITE-COLLAR CRIME

What Is White-Collar Crime? ..................................................................................................... 4.301

Public Perceptions of White-Collar Crime ............................................................................... 4.303

Crimes of the Middle ClassesA Look at White-Collar Crime .................................................. 4.306

ORGANIZATIONAL CRIME

Corporate Organization and Criminal Behavior ..................................................................... 4.402

Opportunities for Unlawful Organizational Behavior ............................................................ 4.404

Corporate Executives and Criminal Liability ........................................................................... 4.409

Management Behavior ................................................................................................................. 4.411Controlling Organizational Crime ............................................................................................. 4.412

Corporate Sentencing Guidelines .............................................................................................. 4.416

Prosecuting Organizational Fraud ............................................................................................. 4.423

OCCUPATIONAL FRAUD

Research in Occupational Fraud and Abuse ............................................................................ 4.501

FRAUD PREVENTION PROGRAMS

Responsibility for Fraud Prevention ......................................................................................... 4.601

Implementing an Effective Compliance and Ethics Program Under the Corporate

Sentencing Guidelines .............................................................................................................. 4.608

Procedures to Prevent Fraud ...................................................................................................... 4.618

Fraud Prevention Policy .............................................................................................................. 4.624

Ethics Programs ........................................................................................................................... 4.628

Sample Corporate Compliance Program .................................................................................. 4.632

Sample Fraud Policy .................................................................................................................... 4.643

Fraud Policy Decision Matrix ..................................................................................................... 4.647


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FRAUD PREVENTION AND DETERRENCE

FRAUD PREVENTION PROGRAMS (CONT.)

Sample Code of Business Ethics and Conduct........................................................................ 4.648

FRAUD RISK ASSESSMENT

What Is Fraud Risk? .................................................................................................................... 4.701

What Factors Influence Fraud Risk? ......................................................................................... 4.701

What Is a Fraud Risk Assessment? ............................................................................................ 4.703

Preparing the Company for a Fraud Risk Assessment ........................................................... 4.710

Fraud Risk Assessment Frameworks ........................................................................................ 4.713

Addressing the Identified Fraud Risks ...................................................................................... 4.723

Responding to Residual Fraud Risks ......................................................................................... 4.725

Reporting the Results of the Fraud Risk Assessment ............................................................. 4.726

Making an Impact with the Fraud Risk Assessment ............................................................... 4.729

The Fraud Risk Assessment and the Audit Process ............................................................... 4.731The Fraud Risk Assessment Tool .............................................................................................. 4.732

FRAUD RISK MANAGEMENT

What Is Risk Management? ........................................................................................................ 4.801

Risk Management Frameworks .................................................................................................. 4.802

Integrating Anti-Fraud Initiatives into Risk Management ..................................................... 4.805

Who Is Responsible for Managing Fraud Risk? ...................................................................... 4.806

The Objectives of a Fraud Risk Management Program ......................................................... 4.810

Steps in Developing a Fraud Risk Management Program ..................................................... 4.811

Fraud Risk Management Program Components ..................................................................... 4.814

MANAGEMENTS, AUDITORS, AND FRAUD EXAMINERSRESPONSIBILITIES

Legislation and Best Practices .................................................................................................... 4.901

Managements Fraud-Related Responsibilities ........................................................................ 4.920

External Auditors Fraud-Related Responsibilities ................................................................. 4.924

Internal Auditors Fraud-Related Responsibilities .................................................................. 4.943

GAO Auditing Standards ........................................................................................................... 4.948

Certified Fraud Examiners Responsibilities............................................................................ 4.957

Sample Document Retention Policy ......................................................................................... 4.960

Sample Document Retention Schedule .................................................................................... 4.966

CORPORATE GOVERNANCE

What Is Corporate Governance? ............................................................................................... 4.1001

Principles of Corporate Governance ........................................................................................ 4.1004

Establishing a Corporate Governance Framework ................................................................. 4.1006


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ETHICS FOR FRAUD EXAMINERS

What Is Ethics? ............................................................................................................................ 4.1101

Morality, Ethics, and Legality ..................................................................................................... 4.1103

Some Concluding Remarks......................................................................................................... 4.1107

ACFE CODE OF PROFESSIONAL ETHICS

Commitment to Professionalism and Diligence ...................................................................... 4.1202

Legal and Ethical Conduct and Conflict of Interest ............................................................... 4.1206

Integrity and Competence........................................................................................................... 4.1209

Court Orders and Testimony ..................................................................................................... 4.1212

Reasonable Evidential Basis for Opinions ............................................................................... 4.1213

Confidential Information ............................................................................................................ 4.1216

Complete Reporting of Material Matters .................................................................................. 4.1221

Professional Improvement ......................................................................................................... 4.1223Professional Standards and Practices ........................................................................................ 4.1224

CFE CODE OF PROFESSIONAL STANDARDS

CFE Code of Professional Standards ....................................................................................... 4.1301