Audit

Catching health care fraud with statistical graphics

Inflating codes that determine how much Medicare and Medicaid pay to health care providers is common practice among fraudsters. Now they’re doing it in increasingly sophisticated ways. Here we examine how statistical graphics can help spot upcoding in what can be an arcane and complicated billing process.

Using technology-assisted review to uncover suspicious transactions

Technology-assisted review (TAR) has been used for nearly two decades in e-discovery matters to reduce costs, increase efficiencies and speed up the often tedious task of manually reviewing emails and user documents for relevance. Fraud examiners can also use TAR techniques (with some guard rails) to find potentially improper payments (PIPs) or transactions in structured data.

Gogi Overhoff, CFE

Long before she became a fraud examiner, Gogi Overhoff, CFE, had her sights set on becoming an actress. But instead of a life on stage, she shines a spotlight on licensed accountants accused of defrauding their clients in her role as an investigator for the California Board of Accountancy.

Stanch the flow

Fraudsters have stolen an unprecedented amount of U.S. COVID-19 relief funds — possibly more than the GDPs of many world economies. But millions of dollars had already been streaming from government programs long before the pandemic, and those cases hold valuable lessons. Here’s how to stanch the flow of money from vulnerable agencies.

Fraud Triangle Analytics, 12 years later

It’s been over a decade since we examined Fraud Triangle Analytics, a method of risk ranking individuals by applying keywords for pressure, opportunity and rationalization to electronic communications. Here we look at how advancements in technology have helped improve FTA in today’s battles with tech-savvy fraudsters.

A roadmap for managing ESG risks

Fraud examiners don’t need cutting-edge techniques to fight fraud in the burgeoning area of environmental, social and governance (ESG) initiatives. They can simply build on existing tools and guides to mitigate those risks, according to the latest report from the ACFE and Grant Thornton LLP, "Managing Fraud Risks in an Evolving ESG Environment."

Bankruptcy fraud, which lessened during the pandemic, could increase this year

U.S. bankruptcies — and bankruptcy fraud — greatly decreased during the pandemic because of temporary lifelines. But as government stimulus, pliant lenders, and cheap and easy funding dissipates, we’re seeing crimes rise. Changes in U.S. federal bankruptcy law could accelerate prosecution of bankruptcy fraud.

Fraud and the lure of corporate estimates

What if a company could significantly improve its financial results, regardless of reality? That opportunity exists today. The fallout from the COVID pandemic has made financial estimates increasingly difficult to calculate and open to manipulation and fraud. Here’s why.

Inside job

While external fraudsters who absconded with billions of dollars in pandemic relief have dominated headlines, less attention has been paid to employees scamming those very same programs. Here we spotlight internal fraud at state agencies and what organizations can do to fight this pernicious type of fraud.

‘Fruitcake fraud’ teaches small businesses lessons in internal controls

Management at Collin Street Bakery, the maker of famous fruitcakes, trusted its close-knit family of employees. Big mistake. That faith cost the company close to $17 million in a massive fraud that serves as an excellent case history.

Fraud examiners have a plethora of data analytics tools

It’s a fact: Data monitoring and analysis can help catch fraudsters. Here’s a primer on incorporating data analysis into your organization along with the latest ACFE tools.

Green gremlins

Having an environmental, social and governance strategy has become all-important for companies. But as criticism over misleading and fraudulent claims grow, regulators are clamping down and pushing to clarify ESG disclosure rules. As they do in financial reporting, CFEs will have a big role to play in this hot but nascent corner of the market.