2018 Int Fraud Examiners Manual 6t1t50
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION TABLE OF CONTENTS
VOLUME I SECTION 1 FINANCIAL TRANSACTIONS AND FRAUD SCHEMES ING CONCEPTS ing Basics ........................................................................................................................ Financial Statements .................................................................................................................... Generally Accepted ing Principles (GAAP) ..............................................................
1.101 1.105 1.115
FINANCIAL STATEMENT FRAUD What Is Financial Statement Fraud?.......................................................................................... The Cost of Financial Statement Fraud .................................................................................... Why Financial Statement Fraud Is Committed ....................................................................... Trends in Financial Statement Fraud ........................................................................................ Financial Statement Fraud Schemes .......................................................................................... What Red Flags Are Associated with Financial Statement Fraud in General? ................... Detection of Fraudulent Financial Statement Schemes ......................................................... Financial Statement Analysis ...................................................................................................... Interviews in Fraudulent Financial Statement Cases .............................................................. Prevention of Financial Statement Fraud .................................................................................
1.203 1.204 1.204 1.206 1.206 1.233 1.234 1.237 1.244 1.253
ASSET MISAPPROPRIATION: CASH RECEIPTS Skimming ....................................................................................................................................... Cash Larceny................................................................................................................................. Theft of Cash on Hand ...............................................................................................................
1.301 1.320 1.333
ASSET MISAPPROPRIATION: FRAUDULENT DISBURSEMENTS Disbursement Schemes ................................................................................................ Check Tampering Schemes ........................................................................................................ Electronic Payment Tampering ................................................................................................. Billing Schemes............................................................................................................................. Payroll Fraud Schemes ................................................................................................................ Expense Reimbursement Schemes ............................................................................................
1.401 1.410 1.433 1.436 1.455 1.473
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FINANCIAL TRANSACTIONS AND FRAUD SCHEMES ASSET MISAPPROPRIATION: INVENTORY AND OTHER ASSETS Misuse of Inventory and Other Assets ..................................................................................... Theft of Inventory and Other Assets........................................................................................ Misappropriation of Intangible Assets ......................................................................................
1.501 1.502 1.518
BRIBERY AND CORRUPTION Corruption..................................................................................................................................... Detection of Bribery Schemes ................................................................................................... Conflicts of Interest ..................................................................................................................... Anti-Corruption Programs .........................................................................................................
1.601 1.611 1.627 1.638
THEFT OF DATA AND INTELLECTUAL PROPERTY Competitive Intelligence Versus Espionage............................................................................. Where Intelligence Professionals Get Information ................................................................ Favorite Employee Targets of Intelligence Professionals ...................................................... How Information Is Lost or Stolen .......................................................................................... Electronic Countersurveillance .................................................................................................. Insider Threats to Proprietary Information ............................................................................. Investigating Corporate Espionage ........................................................................................... Program for Safeguarding Proprietary Information ............................................................... Minimizing the Risks of Misappropriation Claims..................................................................
1.701 1.704 1.712 1.713 1.735 1.736 1.741 1.743 1.755
IDENTITY THEFT What Is Identity Theft? ............................................................................................................... Perpetrators of Identity Theft .................................................................................................... Victims of Identity Theft ............................................................................................................ Methods of Committing Identity Theft .................................................................................... Types of Identity Theft Schemes ............................................................................................... How Identity Thieves Steal Information .................................................................................. Methods of Preventing Identity Theft ...................................................................................... How to Respond to Identity Theft............................................................................................
1.801 1.801 1.802 1.803 1.804 1.808 1.814 1.816
FINANCIAL INSTITUTION FRAUD Embezzlement Schemes ............................................................................................................. Loan Fraud .................................................................................................................................... Real Estate Fraud ......................................................................................................................... New Fraud Schemes ....................................................................................................
1.901 1.905 1.916 1.929
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FINANCIAL TRANSACTIONS AND FRAUD SCHEMES FINANCIAL INSTITUTION FRAUD (CONT.) Money Transfer (Wire) Fraud Schemes .................................................................................... Automated Teller Machine (ATM) Fraud ................................................................................ Takeover ........................................................................................................................ Advance-Fee Fraud ...................................................................................................................... Letter-of-Credit Fraud ................................................................................................................. Inside/Outside Frauds ................................................................................................................ Prevention ..................................................................................................................................... Suspicious Transaction Reports ................................................................................................. The Basel Committee on Banking Supervision .......................................................................
1.932 1.936 1.937 1.938 1.939 1.939 1.940 1.942 1.943
PAYMENT FRAUD Check Fraud .................................................................................................................................. Credit Card Fraud ........................................................................................................................ Prevention and Detection of Credit Card Fraud ..................................................................... Electronic Bill Payment and Person-to-Person Payments ..................................................... Online and Mobile Fraud ........................................................................................... Alternative Currencies .................................................................................................................
1.1001 1.1011 1.1019 1.1026 1.1034 1.1036
INSURANCE FRAUD Types of Insurance Policies ........................................................................................................ Agent/Broker Fraud .................................................................................................................... Underwriting Irregularities.......................................................................................................... Vehicle Insurance Schemes ........................................................................................................ Property Schemes......................................................................................................................... Life Insurance Schemes............................................................................................................... Liability Schemes .......................................................................................................................... Red Flags of Insurance Fraud .................................................................................................... Computer-Generated Detection Reports ................................................................................. Workers’ Compensation Fraud ..................................................................................................
1.1101 1.1102 1.1103 1.1105 1.1108 1.1108 1.1109 1.1109 1.1113 1.1114
HEALTH CARE FRAUD Introduction .................................................................................................................................. Types of Health Care Systems ................................................................................................... Provider Fraud .............................................................................................................................. Fraud by the Medical Staff .......................................................................................................... Inflated Billings............................................................................................................................. Kickbacks in the Health Care Industry .....................................................................................
1.1201 1.1201 1.1205 1.1211 1.1212 1.1216
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FINANCIAL TRANSACTIONS AND FRAUD SCHEMES HEALTH CARE FRAUD (CONT.) Fraud by Medical Institutions .................................................................................................... Other Frauds in the Institutional Setting.................................................................................. Fraud in Special Care Facilities .................................................................................................. Insured and Beneficiary Fraud ................................................................................................... Fraud by Insurance Companies ................................................................................................. Employee Claims Fraud .............................................................................................................. Electronic Claims Fraud..............................................................................................................
1.1218 1.1224 1.1225 1.1228 1.1230 1.1232 1.1234
CONSUMER FRAUD Consumer Fraud Schemes .......................................................................................................... Elder Fraud ................................................................................................................................... Telemarketing Fraud.................................................................................................................... Ponzi and Pyramid Schemes ......................................................................................................
1.1301 1.1313 1.1316 1.1334
COMPUTER AND INTERNET FRAUD Computer Fraud ........................................................................................................................... Computer Hacking....................................................................................................................... Malware ......................................................................................................................................... Email .............................................................................................................................................. Internet Fraud ............................................................................................................................... Electronic Commerce and Information Security .................................................................... Insider Threats.............................................................................................................................. Computer Security .......................................................................................................................
1.1402 1.1403 1.1417 1.1430 1.1433 1.1434 1.1437 1.1439
CONTRACT AND PROCUREMENT FRAUD Basics of Contract Law ............................................................................................................... Methods of Procurement ............................................................................................................ Phases in the Procurement Process........................................................................................... Categories of Procurement Fraud Schemes ............................................................................. Preventing Contract and Procurement Fraud..........................................................................
1.1501 1.1503 1.1507 1.1511 1.1534
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION SECTION 2 LAW OVERVIEW OF THE LEGAL SYSTEM Basic Concepts of the Law ......................................................................................................... Types of Legal Systems ............................................................................................................... International Issues in Fraud Cases ........................................................................................... Court Systems ............................................................................................................................... Civil and Criminal Actions for Fraud ........................................................................................
2.101 2.104 2.110 2.112 2.113
THE LAW RELATED TO FRAUD Definition of Fraud ...................................................................................................................... Principal Types of Fraud ............................................................................................................. International Initiatives Against Fraud and Corruption .........................................................
2.201 2.201 2.221
BANKRUPTCY (INSOLVENCY) FRAUD Introduction .................................................................................................................................. Key Parties in the Bankruptcy System ...................................................................................... Types of Bankruptcy Filings ....................................................................................................... Bankruptcy Schemes.................................................................................................................... Cross-Border Insolvency Regimes ............................................................................................ The World Bank Principles ........................................................................................................
2.301 2.301 2.306 2.307 2.310 2.311
SECURITIES FRAUD Introduction .................................................................................................................................. What Constitutes a Security? ...................................................................................................... Securities Laws and Regulations ................................................................................................ Securities Fraud Schemes ............................................................................................................ Investigative Tips .........................................................................................................................
2.401 2.401 2.423 2.439 2.454
MONEY LAUNDERING Introduction .................................................................................................................................. The Money Laundering Process ................................................................................................ Money Laundering Methods ...................................................................................................... International Anti-Money Laundering Efforts ........................................................................ Enforcement and Prevention Strategies ................................................................................... Special Problems for Insurance Companies ............................................................................
2.501 2.501 2.504 2.527 2.539 2.542
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION LAW TAX FRAUD Introduction .................................................................................................................................. Evidence of Tax Fraud ................................................................................................................ Types of Tax Evasion Schemes ................................................................................................. Common Defenses to Allegations of Tax Fraud ....................................................................
2.601 2.603 2.604 2.606
INDIVIDUAL RIGHTS DURING EXAMINATIONS Employees’ Duties and Rights During Investigations ............................................................ Rights and Obligations Under Criminal Law ........................................................................... The Law Relating to Government Search and Seizure........................................................... Investigations in Private Actions ...............................................................................................
2.701 2.707 2.713 2.716
THE CRIMINAL JUSTICE SYSTEM International Covenant on Civil and Political Rights ............................................................. The Charging Process.................................................................................................................. Defenses ........................................................................................................................................ The Trial Process ......................................................................................................................... Sentencing ..................................................................................................................................... Appeal ............................................................................................................................................ Punishment ................................................................................................................................... Corporate Criminal Liability .......................................................................................................
2.801 2.803 2.805 2.807 2.816 2.817 2.817 2.817
THE CIVIL JUSTICE SYSTEM Introduction .................................................................................................................................. Procedure in Civil Cases ............................................................................................................. Decisions and Remedies in Civil Cases..................................................................................... Alternative Dispute Resolution ..................................................................................................
2.901 2.901 2.909 2.912
BASIC PRINCIPLES OF EVIDENCE Definition of Evidence ................................................................................................................ Three Basic Forms of Evidence ................................................................................................ Direct Versus Circumstantial Evidence .................................................................................... issibility of Evidence ........................................................................................................... Special Rules Concerning the ission of Evidence in Adversarial Proceedings........... Chain of Custody ......................................................................................................................... Impeachment ................................................................................................................................ Privileges and Protections ...........................................................................................................
2.1001 2.1002 2.1002 2.1003 2.1006 2.1025 2.1027 2.1029
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION LAW TESTIFYING Introduction .................................................................................................................................. Considerations for Testifying as a Lay Witness ....................................................................... Considerations for Testifying as an Expert .............................................................................. Qualifying to Testify as an Expert Witness .............................................................................. Preparing to Testify .................................................................................................................... Direct Examination .................................................................................................................... Cross-Examination ...................................................................................................................... Expressing an Opinion on Guilt................................................................................................ Summary ........................................................................................................................................
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2.1101 2.1102 2.1105 2.1111 2.1114 2.1117 2.1122 2.1130 2.1131
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VOLUME II SECTION 3 INVESTIGATION PLANNING AND CONDUCTING A FRAUD EXAMINATION Why Conduct a Fraud Examination? ........................................................................................ What Fraud Examination Entails .............................................................................................. Fraud Examination and Forensic ing ......................................................................... Fraud Examination Methodology.............................................................................................. Develop a Fraud Response Plan ................................................................................................ Initial Response to Suspicions or Allegations of Fraud ......................................................... Planning and Conducting a Formal Investigation ................................................................... Structure the Investigation to Preserve Confidentiality .........................................................
3.101 3.102 3.103 3.104 3.111 3.115 3.123 3.143
ANALYZING DOCUMENTS Obtaining Documentary Evidence ............................................................................................ Examining Fraudulent Documents ........................................................................................... Handling Documents as Physical Evidence ............................................................................. Identifying Writings ..................................................................................................................... The Document Expert’s Findings ............................................................................................ How to Obtain Handwriting Samples ...................................................................................... Typewriters and Computer Printers .......................................................................................... Photocopies .................................................................................................................................. Dating a Document ..................................................................................................................... Indented Writings ........................................................................................................................ Counterfeit Printed Documents ................................................................................................ Fingerprints ................................................................................................................................... Sources for Expert Document Examinations..........................................................................
3.201 3.204 3.206 3.209 3.212 3.213 3.215 3.216 3.218 3.221 3.222 3.223 3.225
INTERVIEW THEORY AND APPLICATION Preparation .................................................................................................................................... Characteristics of a Successful Interview .................................................................................. Characteristics of an Effective Interviewer .............................................................................. Legal Considerations When Conducting an Interview ........................................................... Elements of Conversations......................................................................................................... Inhibitors of Communication .................................................................................................... Facilitators of Communication .................................................................................................. Kinesic Interview and Interrogation ......................................................................................... The Cognitive Interview Technique ..........................................................................................
3.301 3.301 3.302 3.303 3.304 3.306 3.309 3.311 3.315
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION INVESTIGATION INTERVIEW THEORY AND APPLICATION (CONT.) PEACE Interviewing Method.................................................................................................... Interview Mechanics .................................................................................................................... Question Typology ...................................................................................................................... Introductory Questions ............................................................................................................... Informational Questions ............................................................................................................. Closing Questions ........................................................................................................................ Assessment Questions .................................................................................................................
3.318 3.320 3.322 3.324 3.332 3.345 3.347
INTERVIEWING SUSPECTS AND SIGNED STATEMENTS ission-Seeking Questions.................................................................................................... Signed Statements ........................................................................................................................ Criteria-Based Statement Analysis .............................................................................................
3.401 3.425 3.428
COVERT EXAMINATIONS Establishing an Identity ............................................................................................................... Objectives...................................................................................................................................... Problems in Covert Operations ................................................................................................. Surveillance ................................................................................................................................... Sources and Informants .............................................................................................................. Use of Operatives ........................................................................................................................
3.502 3.503 3.504 3.507 3.516 3.525
SOURCES OF INFORMATION Public Versus Nonpublic Records............................................................................................. Local Records ............................................................................................................................... Court Records............................................................................................................................... Property Records.......................................................................................................................... Business (Corporate) Filings....................................................................................................... Other Agency Records ................................................................................................................ Nonpublic Records ...................................................................................................................... Other Non-Government Sources.............................................................................................. Accessing Information Online ................................................................................................... Additional Information Sources ................................................................................................
3.602 3.605 3.607 3.612 3.614 3.616 3.620 3.627 3.630 3.661
DATA ANALYSIS AND REPORTING TOOLS Understanding the Need for Data Analysis ............................................................................. Data Mining ..................................................................................................................................
3.701 3.703
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION INVESTIGATION DATA ANALYSIS AND REPORTING TOOLS (CONT.) The Data Analysis Process ......................................................................................................... Spectrum of Analysis ................................................................................................................... Using Data Analysis Software .................................................................................................... Textual Analytics .......................................................................................................................... Visual Analytics ............................................................................................................................ Evaluating Data Analysis Software............................................................................................ Types of Data Mining and Analysis Software .......................................................................... Reporting and Case Management Software .............................................................................
3.705 3.713 3.713 3.736 3.739 3.743 3.745 3.746
DIGITAL FORENSICS Conducting an Investigation Involving Computers................................................................ Computer Investigations and Computer Forensics ................................................................ Investigating in the Cloud ........................................................................................................... Mobile Forensic Investigations .................................................................................................. Digital Forensics Software ..........................................................................................................
3.801 3.814 3.829 3.834 3.840
TRACING ILLICIT TRANSACTIONS General Process for Tracing Illicit Transactions ..................................................................... Direct Methods of Tracing Financial Transactions ................................................................ Indirect Methods of Tracing Financial Transactions.............................................................. Locating Hidden Assets ..............................................................................................................
3.901 3.910 3.940 3.958
REPORT WRITING The Importance of Writing Effective Reports ........................................................................ Preparation .................................................................................................................................... Characteristics of a Good Report .............................................................................................. Common Reporting Mistakes .................................................................................................... Organization of Information ...................................................................................................... Analyzing the Reader ................................................................................................................... Outlining........................................................................................................................................ Grammatical Considerations ...................................................................................................... Report Structure ........................................................................................................................... Reporting Documents ................................................................................................................. Visual Aids .................................................................................................................................... Presenting the Case to Prosecutors and Other Government Authorities ...........................
3.1001 3.1002 3.1003 3.1006 3.1010 3.1010 3.1012 3.1013 3.1018 3.1025 3.1029 3.1034
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION INVESTIGATION APPENDIX A: ENGAGEMENT AND ADVISORY LETTERS Fraud Examination Engagement Letters.................................................................................. 3.1101 Fraud Examination Advisory Letters ........................................................................................ 3.1103 APPENDIX B: FRAUD EXAMINATION CHECKLIST Fraud Examination Checklist ..................................................................................................... 3.1201 APPENDIX C: SAMPLE FORMS Consent to Search ........................................................................................................................ Customer Consent and Authorization for Access to Financial Records ............................. Fraud Incident Report Log ......................................................................................................... Inventory of Evidence and Chain of Custody Log ................................................................. Evidence Control Log .................................................................................................................
3.1301 3.1303 3.1304 3.1306 3.1307
APPENDIX D: ADDITIONAL INFORMATION SOURCES Directories ..................................................................................................................................... 3.1401 Banks and Financial Institutions ................................................................................................ 3.1407 International Law Enforcement Organizations....................................................................... 3.1409 APPENDIX E: SAMPLE FRAUD EXAMINATION REPORTS Short-Form Report ...................................................................................................................... 3.1502 Long-Form Report ...................................................................................................................... 3.1509
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SECTION 4 FRAUD PREVENTION AND DETERRENCE UNDERSTANDING CRIMINAL BEHAVIOR Behavioral Analysis and the Prevention of Fraud ................................................................... Why People Obey the Law ......................................................................................................... Theories of Crime Causation .....................................................................................................
4.101 4.108 4.117
WHITE-COLLAR CRIME What Is White-Collar Crime? ..................................................................................................... Crimes of the Middle Classes—A Look at White-Collar Crime .................................................. Organizational Crime .................................................................................................................. Occupational Fraud ..................................................................................................................... Research in Occupational Fraud and Abuse ............................................................................
4.201 4.203 4.212 4.226 4.227
CORPORATE GOVERNANCE What Is Corporate Governance? ............................................................................................... Who Is Involved in Corporate Governance?........................................................................... The Role of Corporate Governance in Fighting Fraud.......................................................... Principles of Corporate Governance ........................................................................................ Establishing a Corporate Governance Framework................................................................. Corporate Governance Codes and Guidance ..........................................................................
4.301 4.301 4.306 4.307 4.321 4.322
MANAGEMENT’S FRAUD-RELATED RESPONSIBILITIES The Legal Foundation for Management’s Fraud-Related Responsibilities.......................... Management’s Responsibility for Internal Controls ............................................................... Management’s Responsibility for an Effective Corporate Compliance and Ethics Program .................................................................................................................. Document Retention Policies ....................................................................................................
4.406 4.416
AUDITORS’ FRAUD-RELATED RESPONSIBILITIES External Audit Standards Related to Fraud ............................................................................. Internal Auditors’ Fraud-Related Responsibilities .................................................................. International Standards for Government Auditing.................................................................
4.501 4.525 4.533
FRAUD PREVENTION PROGRAMS Selling Fraud Prevention to Management ................................................................................ Procedures to Prevent Fraud...................................................................................................... Anti-Fraud Policy .........................................................................................................................
4.601 4.602 4.615
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FRAUD PREVENTION AND DETERRENCE FRAUD PREVENTION PROGRAMS (CONT.) Ethics Programs ........................................................................................................................... Sample Anti-Fraud Policy ........................................................................................................... Fraud Policy Decision Matrix..................................................................................................... Sample Code of Business Ethics and Conduct........................................................................
4.620 4.623 4.627 4.628
FRAUD RISK ASSESSMENT What Is Fraud Risk? .................................................................................................................... What Factors Influence Fraud Risk? ......................................................................................... What Is a Fraud Risk Assessment? ............................................................................................ Preparing the Company for a Fraud Risk Assessment ........................................................... Fraud Risk Assessment Frameworks ........................................................................................ Addressing the Identified Fraud Risks ...................................................................................... Responding to Residual Fraud Risks ......................................................................................... Reporting the Results of the Fraud Risk Assessment ............................................................. Making an Impact with the Fraud Risk Assessment ............................................................... The Fraud Risk Assessment and the Audit Process ............................................................... The Fraud Risk Assessment Tool ..............................................................................................
4.701 4.701 4.703 4.710 4.714 4.724 4.726 4.728 4.730 4.732 4.733
FRAUD RISK MANAGEMENT Foundational Guidance for Fraud Risk Management ............................................................ What Is Risk Management? ........................................................................................................ Risk Management Frameworks .................................................................................................. Integrating Anti-Fraud Initiatives into Risk Management ..................................................... Who Is Responsible for Managing Fraud Risk? ...................................................................... The Objectives of a Fraud Risk Management Program ......................................................... Fraud Risk Management Principles ........................................................................................... Steps in Developing a Fraud Risk Management Program ..................................................... Fraud Risk Management Program Components ..................................................................... The Use of Data Analytics in Managing Fraud Risk ..............................................................
4.801 4.801 4.803 4.808 4.811 4.816 4.817 4.821 4.825 4.829
ETHICS FOR FRAUD EXAMINERS What Is Ethics? ............................................................................................................................ Morality, Ethics, and Legality ..................................................................................................... Some Concluding Remarks.........................................................................................................
4.901 4.903 4.907
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FRAUD PREVENTION AND DETERRENCE ACFE CODE OF PROFESSIONAL ETHICS Commitment to Professionalism and Diligence ...................................................................... Legal and Ethical Conduct and Conflict of Interest ............................................................... Integrity and Competence........................................................................................................... Court Orders and Testimony ..................................................................................................... Reasonable Evidential Basis for Opinions ............................................................................... Confidential Information ............................................................................................................ Complete Reporting of Material Matters .................................................................................. Professional Improvement .........................................................................................................
4.1002 4.1005 4.1009 4.1012 4.1014 4.1017 4.1022 4.1023
CFE CODE OF PROFESSIONAL STANDARDS CFE Code of Professional Standards ....................................................................................... 4.1101
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VOLUME I SECTION 1 FINANCIAL TRANSACTIONS AND FRAUD SCHEMES ING CONCEPTS ing Basics ........................................................................................................................ Financial Statements .................................................................................................................... Generally Accepted ing Principles (GAAP) ..............................................................
1.101 1.105 1.115
FINANCIAL STATEMENT FRAUD What Is Financial Statement Fraud?.......................................................................................... The Cost of Financial Statement Fraud .................................................................................... Why Financial Statement Fraud Is Committed ....................................................................... Trends in Financial Statement Fraud ........................................................................................ Financial Statement Fraud Schemes .......................................................................................... What Red Flags Are Associated with Financial Statement Fraud in General? ................... Detection of Fraudulent Financial Statement Schemes ......................................................... Financial Statement Analysis ...................................................................................................... Interviews in Fraudulent Financial Statement Cases .............................................................. Prevention of Financial Statement Fraud .................................................................................
1.203 1.204 1.204 1.206 1.206 1.233 1.234 1.237 1.244 1.253
ASSET MISAPPROPRIATION: CASH RECEIPTS Skimming ....................................................................................................................................... Cash Larceny................................................................................................................................. Theft of Cash on Hand ...............................................................................................................
1.301 1.320 1.333
ASSET MISAPPROPRIATION: FRAUDULENT DISBURSEMENTS Disbursement Schemes ................................................................................................ Check Tampering Schemes ........................................................................................................ Electronic Payment Tampering ................................................................................................. Billing Schemes............................................................................................................................. Payroll Fraud Schemes ................................................................................................................ Expense Reimbursement Schemes ............................................................................................
1.401 1.410 1.433 1.436 1.455 1.473
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FINANCIAL TRANSACTIONS AND FRAUD SCHEMES ASSET MISAPPROPRIATION: INVENTORY AND OTHER ASSETS Misuse of Inventory and Other Assets ..................................................................................... Theft of Inventory and Other Assets........................................................................................ Misappropriation of Intangible Assets ......................................................................................
1.501 1.502 1.518
BRIBERY AND CORRUPTION Corruption..................................................................................................................................... Detection of Bribery Schemes ................................................................................................... Conflicts of Interest ..................................................................................................................... Anti-Corruption Programs .........................................................................................................
1.601 1.611 1.627 1.638
THEFT OF DATA AND INTELLECTUAL PROPERTY Competitive Intelligence Versus Espionage............................................................................. Where Intelligence Professionals Get Information ................................................................ Favorite Employee Targets of Intelligence Professionals ...................................................... How Information Is Lost or Stolen .......................................................................................... Electronic Countersurveillance .................................................................................................. Insider Threats to Proprietary Information ............................................................................. Investigating Corporate Espionage ........................................................................................... Program for Safeguarding Proprietary Information ............................................................... Minimizing the Risks of Misappropriation Claims..................................................................
1.701 1.704 1.712 1.713 1.735 1.736 1.741 1.743 1.755
IDENTITY THEFT What Is Identity Theft? ............................................................................................................... Perpetrators of Identity Theft .................................................................................................... Victims of Identity Theft ............................................................................................................ Methods of Committing Identity Theft .................................................................................... Types of Identity Theft Schemes ............................................................................................... How Identity Thieves Steal Information .................................................................................. Methods of Preventing Identity Theft ...................................................................................... How to Respond to Identity Theft............................................................................................
1.801 1.801 1.802 1.803 1.804 1.808 1.814 1.816
FINANCIAL INSTITUTION FRAUD Embezzlement Schemes ............................................................................................................. Loan Fraud .................................................................................................................................... Real Estate Fraud ......................................................................................................................... New Fraud Schemes ....................................................................................................
1.901 1.905 1.916 1.929
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION
FINANCIAL TRANSACTIONS AND FRAUD SCHEMES FINANCIAL INSTITUTION FRAUD (CONT.) Money Transfer (Wire) Fraud Schemes .................................................................................... Automated Teller Machine (ATM) Fraud ................................................................................ Takeover ........................................................................................................................ Advance-Fee Fraud ...................................................................................................................... Letter-of-Credit Fraud ................................................................................................................. Inside/Outside Frauds ................................................................................................................ Prevention ..................................................................................................................................... Suspicious Transaction Reports ................................................................................................. The Basel Committee on Banking Supervision .......................................................................
1.932 1.936 1.937 1.938 1.939 1.939 1.940 1.942 1.943
PAYMENT FRAUD Check Fraud .................................................................................................................................. Credit Card Fraud ........................................................................................................................ Prevention and Detection of Credit Card Fraud ..................................................................... Electronic Bill Payment and Person-to-Person Payments ..................................................... Online and Mobile Fraud ........................................................................................... Alternative Currencies .................................................................................................................
1.1001 1.1011 1.1019 1.1026 1.1034 1.1036
INSURANCE FRAUD Types of Insurance Policies ........................................................................................................ Agent/Broker Fraud .................................................................................................................... Underwriting Irregularities.......................................................................................................... Vehicle Insurance Schemes ........................................................................................................ Property Schemes......................................................................................................................... Life Insurance Schemes............................................................................................................... Liability Schemes .......................................................................................................................... Red Flags of Insurance Fraud .................................................................................................... Computer-Generated Detection Reports ................................................................................. Workers’ Compensation Fraud ..................................................................................................
1.1101 1.1102 1.1103 1.1105 1.1108 1.1108 1.1109 1.1109 1.1113 1.1114
HEALTH CARE FRAUD Introduction .................................................................................................................................. Types of Health Care Systems ................................................................................................... Provider Fraud .............................................................................................................................. Fraud by the Medical Staff .......................................................................................................... Inflated Billings............................................................................................................................. Kickbacks in the Health Care Industry .....................................................................................
1.1201 1.1201 1.1205 1.1211 1.1212 1.1216
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION
FINANCIAL TRANSACTIONS AND FRAUD SCHEMES HEALTH CARE FRAUD (CONT.) Fraud by Medical Institutions .................................................................................................... Other Frauds in the Institutional Setting.................................................................................. Fraud in Special Care Facilities .................................................................................................. Insured and Beneficiary Fraud ................................................................................................... Fraud by Insurance Companies ................................................................................................. Employee Claims Fraud .............................................................................................................. Electronic Claims Fraud..............................................................................................................
1.1218 1.1224 1.1225 1.1228 1.1230 1.1232 1.1234
CONSUMER FRAUD Consumer Fraud Schemes .......................................................................................................... Elder Fraud ................................................................................................................................... Telemarketing Fraud.................................................................................................................... Ponzi and Pyramid Schemes ......................................................................................................
1.1301 1.1313 1.1316 1.1334
COMPUTER AND INTERNET FRAUD Computer Fraud ........................................................................................................................... Computer Hacking....................................................................................................................... Malware ......................................................................................................................................... Email .............................................................................................................................................. Internet Fraud ............................................................................................................................... Electronic Commerce and Information Security .................................................................... Insider Threats.............................................................................................................................. Computer Security .......................................................................................................................
1.1402 1.1403 1.1417 1.1430 1.1433 1.1434 1.1437 1.1439
CONTRACT AND PROCUREMENT FRAUD Basics of Contract Law ............................................................................................................... Methods of Procurement ............................................................................................................ Phases in the Procurement Process........................................................................................... Categories of Procurement Fraud Schemes ............................................................................. Preventing Contract and Procurement Fraud..........................................................................
1.1501 1.1503 1.1507 1.1511 1.1534
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION SECTION 2 LAW OVERVIEW OF THE LEGAL SYSTEM Basic Concepts of the Law ......................................................................................................... Types of Legal Systems ............................................................................................................... International Issues in Fraud Cases ........................................................................................... Court Systems ............................................................................................................................... Civil and Criminal Actions for Fraud ........................................................................................
2.101 2.104 2.110 2.112 2.113
THE LAW RELATED TO FRAUD Definition of Fraud ...................................................................................................................... Principal Types of Fraud ............................................................................................................. International Initiatives Against Fraud and Corruption .........................................................
2.201 2.201 2.221
BANKRUPTCY (INSOLVENCY) FRAUD Introduction .................................................................................................................................. Key Parties in the Bankruptcy System ...................................................................................... Types of Bankruptcy Filings ....................................................................................................... Bankruptcy Schemes.................................................................................................................... Cross-Border Insolvency Regimes ............................................................................................ The World Bank Principles ........................................................................................................
2.301 2.301 2.306 2.307 2.310 2.311
SECURITIES FRAUD Introduction .................................................................................................................................. What Constitutes a Security? ...................................................................................................... Securities Laws and Regulations ................................................................................................ Securities Fraud Schemes ............................................................................................................ Investigative Tips .........................................................................................................................
2.401 2.401 2.423 2.439 2.454
MONEY LAUNDERING Introduction .................................................................................................................................. The Money Laundering Process ................................................................................................ Money Laundering Methods ...................................................................................................... International Anti-Money Laundering Efforts ........................................................................ Enforcement and Prevention Strategies ................................................................................... Special Problems for Insurance Companies ............................................................................
2.501 2.501 2.504 2.527 2.539 2.542
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION LAW TAX FRAUD Introduction .................................................................................................................................. Evidence of Tax Fraud ................................................................................................................ Types of Tax Evasion Schemes ................................................................................................. Common Defenses to Allegations of Tax Fraud ....................................................................
2.601 2.603 2.604 2.606
INDIVIDUAL RIGHTS DURING EXAMINATIONS Employees’ Duties and Rights During Investigations ............................................................ Rights and Obligations Under Criminal Law ........................................................................... The Law Relating to Government Search and Seizure........................................................... Investigations in Private Actions ...............................................................................................
2.701 2.707 2.713 2.716
THE CRIMINAL JUSTICE SYSTEM International Covenant on Civil and Political Rights ............................................................. The Charging Process.................................................................................................................. Defenses ........................................................................................................................................ The Trial Process ......................................................................................................................... Sentencing ..................................................................................................................................... Appeal ............................................................................................................................................ Punishment ................................................................................................................................... Corporate Criminal Liability .......................................................................................................
2.801 2.803 2.805 2.807 2.816 2.817 2.817 2.817
THE CIVIL JUSTICE SYSTEM Introduction .................................................................................................................................. Procedure in Civil Cases ............................................................................................................. Decisions and Remedies in Civil Cases..................................................................................... Alternative Dispute Resolution ..................................................................................................
2.901 2.901 2.909 2.912
BASIC PRINCIPLES OF EVIDENCE Definition of Evidence ................................................................................................................ Three Basic Forms of Evidence ................................................................................................ Direct Versus Circumstantial Evidence .................................................................................... issibility of Evidence ........................................................................................................... Special Rules Concerning the ission of Evidence in Adversarial Proceedings........... Chain of Custody ......................................................................................................................... Impeachment ................................................................................................................................ Privileges and Protections ...........................................................................................................
2.1001 2.1002 2.1002 2.1003 2.1006 2.1025 2.1027 2.1029
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION LAW TESTIFYING Introduction .................................................................................................................................. Considerations for Testifying as a Lay Witness ....................................................................... Considerations for Testifying as an Expert .............................................................................. Qualifying to Testify as an Expert Witness .............................................................................. Preparing to Testify .................................................................................................................... Direct Examination .................................................................................................................... Cross-Examination ...................................................................................................................... Expressing an Opinion on Guilt................................................................................................ Summary ........................................................................................................................................
Fraud Examiners Manual: 2018 International Edition
2.1101 2.1102 2.1105 2.1111 2.1114 2.1117 2.1122 2.1130 2.1131
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VOLUME II SECTION 3 INVESTIGATION PLANNING AND CONDUCTING A FRAUD EXAMINATION Why Conduct a Fraud Examination? ........................................................................................ What Fraud Examination Entails .............................................................................................. Fraud Examination and Forensic ing ......................................................................... Fraud Examination Methodology.............................................................................................. Develop a Fraud Response Plan ................................................................................................ Initial Response to Suspicions or Allegations of Fraud ......................................................... Planning and Conducting a Formal Investigation ................................................................... Structure the Investigation to Preserve Confidentiality .........................................................
3.101 3.102 3.103 3.104 3.111 3.115 3.123 3.143
ANALYZING DOCUMENTS Obtaining Documentary Evidence ............................................................................................ Examining Fraudulent Documents ........................................................................................... Handling Documents as Physical Evidence ............................................................................. Identifying Writings ..................................................................................................................... The Document Expert’s Findings ............................................................................................ How to Obtain Handwriting Samples ...................................................................................... Typewriters and Computer Printers .......................................................................................... Photocopies .................................................................................................................................. Dating a Document ..................................................................................................................... Indented Writings ........................................................................................................................ Counterfeit Printed Documents ................................................................................................ Fingerprints ................................................................................................................................... Sources for Expert Document Examinations..........................................................................
3.201 3.204 3.206 3.209 3.212 3.213 3.215 3.216 3.218 3.221 3.222 3.223 3.225
INTERVIEW THEORY AND APPLICATION Preparation .................................................................................................................................... Characteristics of a Successful Interview .................................................................................. Characteristics of an Effective Interviewer .............................................................................. Legal Considerations When Conducting an Interview ........................................................... Elements of Conversations......................................................................................................... Inhibitors of Communication .................................................................................................... Facilitators of Communication .................................................................................................. Kinesic Interview and Interrogation ......................................................................................... The Cognitive Interview Technique ..........................................................................................
3.301 3.301 3.302 3.303 3.304 3.306 3.309 3.311 3.315
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION INVESTIGATION INTERVIEW THEORY AND APPLICATION (CONT.) PEACE Interviewing Method.................................................................................................... Interview Mechanics .................................................................................................................... Question Typology ...................................................................................................................... Introductory Questions ............................................................................................................... Informational Questions ............................................................................................................. Closing Questions ........................................................................................................................ Assessment Questions .................................................................................................................
3.318 3.320 3.322 3.324 3.332 3.345 3.347
INTERVIEWING SUSPECTS AND SIGNED STATEMENTS ission-Seeking Questions.................................................................................................... Signed Statements ........................................................................................................................ Criteria-Based Statement Analysis .............................................................................................
3.401 3.425 3.428
COVERT EXAMINATIONS Establishing an Identity ............................................................................................................... Objectives...................................................................................................................................... Problems in Covert Operations ................................................................................................. Surveillance ................................................................................................................................... Sources and Informants .............................................................................................................. Use of Operatives ........................................................................................................................
3.502 3.503 3.504 3.507 3.516 3.525
SOURCES OF INFORMATION Public Versus Nonpublic Records............................................................................................. Local Records ............................................................................................................................... Court Records............................................................................................................................... Property Records.......................................................................................................................... Business (Corporate) Filings....................................................................................................... Other Agency Records ................................................................................................................ Nonpublic Records ...................................................................................................................... Other Non-Government Sources.............................................................................................. Accessing Information Online ................................................................................................... Additional Information Sources ................................................................................................
3.602 3.605 3.607 3.612 3.614 3.616 3.620 3.627 3.630 3.661
DATA ANALYSIS AND REPORTING TOOLS Understanding the Need for Data Analysis ............................................................................. Data Mining ..................................................................................................................................
3.701 3.703
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION INVESTIGATION DATA ANALYSIS AND REPORTING TOOLS (CONT.) The Data Analysis Process ......................................................................................................... Spectrum of Analysis ................................................................................................................... Using Data Analysis Software .................................................................................................... Textual Analytics .......................................................................................................................... Visual Analytics ............................................................................................................................ Evaluating Data Analysis Software............................................................................................ Types of Data Mining and Analysis Software .......................................................................... Reporting and Case Management Software .............................................................................
3.705 3.713 3.713 3.736 3.739 3.743 3.745 3.746
DIGITAL FORENSICS Conducting an Investigation Involving Computers................................................................ Computer Investigations and Computer Forensics ................................................................ Investigating in the Cloud ........................................................................................................... Mobile Forensic Investigations .................................................................................................. Digital Forensics Software ..........................................................................................................
3.801 3.814 3.829 3.834 3.840
TRACING ILLICIT TRANSACTIONS General Process for Tracing Illicit Transactions ..................................................................... Direct Methods of Tracing Financial Transactions ................................................................ Indirect Methods of Tracing Financial Transactions.............................................................. Locating Hidden Assets ..............................................................................................................
3.901 3.910 3.940 3.958
REPORT WRITING The Importance of Writing Effective Reports ........................................................................ Preparation .................................................................................................................................... Characteristics of a Good Report .............................................................................................. Common Reporting Mistakes .................................................................................................... Organization of Information ...................................................................................................... Analyzing the Reader ................................................................................................................... Outlining........................................................................................................................................ Grammatical Considerations ...................................................................................................... Report Structure ........................................................................................................................... Reporting Documents ................................................................................................................. Visual Aids .................................................................................................................................... Presenting the Case to Prosecutors and Other Government Authorities ...........................
3.1001 3.1002 3.1003 3.1006 3.1010 3.1010 3.1012 3.1013 3.1018 3.1025 3.1029 3.1034
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION INVESTIGATION APPENDIX A: ENGAGEMENT AND ADVISORY LETTERS Fraud Examination Engagement Letters.................................................................................. 3.1101 Fraud Examination Advisory Letters ........................................................................................ 3.1103 APPENDIX B: FRAUD EXAMINATION CHECKLIST Fraud Examination Checklist ..................................................................................................... 3.1201 APPENDIX C: SAMPLE FORMS Consent to Search ........................................................................................................................ Customer Consent and Authorization for Access to Financial Records ............................. Fraud Incident Report Log ......................................................................................................... Inventory of Evidence and Chain of Custody Log ................................................................. Evidence Control Log .................................................................................................................
3.1301 3.1303 3.1304 3.1306 3.1307
APPENDIX D: ADDITIONAL INFORMATION SOURCES Directories ..................................................................................................................................... 3.1401 Banks and Financial Institutions ................................................................................................ 3.1407 International Law Enforcement Organizations....................................................................... 3.1409 APPENDIX E: SAMPLE FRAUD EXAMINATION REPORTS Short-Form Report ...................................................................................................................... 3.1502 Long-Form Report ...................................................................................................................... 3.1509
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FRAUD EXAMINERS MANUAL INTERNATIONAL EDITION
SECTION 4 FRAUD PREVENTION AND DETERRENCE UNDERSTANDING CRIMINAL BEHAVIOR Behavioral Analysis and the Prevention of Fraud ................................................................... Why People Obey the Law ......................................................................................................... Theories of Crime Causation .....................................................................................................
4.101 4.108 4.117
WHITE-COLLAR CRIME What Is White-Collar Crime? ..................................................................................................... Crimes of the Middle Classes—A Look at White-Collar Crime .................................................. Organizational Crime .................................................................................................................. Occupational Fraud ..................................................................................................................... Research in Occupational Fraud and Abuse ............................................................................
4.201 4.203 4.212 4.226 4.227
CORPORATE GOVERNANCE What Is Corporate Governance? ............................................................................................... Who Is Involved in Corporate Governance?........................................................................... The Role of Corporate Governance in Fighting Fraud.......................................................... Principles of Corporate Governance ........................................................................................ Establishing a Corporate Governance Framework................................................................. Corporate Governance Codes and Guidance ..........................................................................
4.301 4.301 4.306 4.307 4.321 4.322
MANAGEMENT’S FRAUD-RELATED RESPONSIBILITIES The Legal Foundation for Management’s Fraud-Related Responsibilities.......................... Management’s Responsibility for Internal Controls ............................................................... Management’s Responsibility for an Effective Corporate Compliance and Ethics Program .................................................................................................................. Document Retention Policies ....................................................................................................
4.406 4.416
AUDITORS’ FRAUD-RELATED RESPONSIBILITIES External Audit Standards Related to Fraud ............................................................................. Internal Auditors’ Fraud-Related Responsibilities .................................................................. International Standards for Government Auditing.................................................................
4.501 4.525 4.533
FRAUD PREVENTION PROGRAMS Selling Fraud Prevention to Management ................................................................................ Procedures to Prevent Fraud...................................................................................................... Anti-Fraud Policy .........................................................................................................................
4.601 4.602 4.615
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FRAUD PREVENTION AND DETERRENCE FRAUD PREVENTION PROGRAMS (CONT.) Ethics Programs ........................................................................................................................... Sample Anti-Fraud Policy ........................................................................................................... Fraud Policy Decision Matrix..................................................................................................... Sample Code of Business Ethics and Conduct........................................................................
4.620 4.623 4.627 4.628
FRAUD RISK ASSESSMENT What Is Fraud Risk? .................................................................................................................... What Factors Influence Fraud Risk? ......................................................................................... What Is a Fraud Risk Assessment? ............................................................................................ Preparing the Company for a Fraud Risk Assessment ........................................................... Fraud Risk Assessment Frameworks ........................................................................................ Addressing the Identified Fraud Risks ...................................................................................... Responding to Residual Fraud Risks ......................................................................................... Reporting the Results of the Fraud Risk Assessment ............................................................. Making an Impact with the Fraud Risk Assessment ............................................................... The Fraud Risk Assessment and the Audit Process ............................................................... The Fraud Risk Assessment Tool ..............................................................................................
4.701 4.701 4.703 4.710 4.714 4.724 4.726 4.728 4.730 4.732 4.733
FRAUD RISK MANAGEMENT Foundational Guidance for Fraud Risk Management ............................................................ What Is Risk Management? ........................................................................................................ Risk Management Frameworks .................................................................................................. Integrating Anti-Fraud Initiatives into Risk Management ..................................................... Who Is Responsible for Managing Fraud Risk? ...................................................................... The Objectives of a Fraud Risk Management Program ......................................................... Fraud Risk Management Principles ........................................................................................... Steps in Developing a Fraud Risk Management Program ..................................................... Fraud Risk Management Program Components ..................................................................... The Use of Data Analytics in Managing Fraud Risk ..............................................................
4.801 4.801 4.803 4.808 4.811 4.816 4.817 4.821 4.825 4.829
ETHICS FOR FRAUD EXAMINERS What Is Ethics? ............................................................................................................................ Morality, Ethics, and Legality ..................................................................................................... Some Concluding Remarks.........................................................................................................
4.901 4.903 4.907
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FRAUD PREVENTION AND DETERRENCE ACFE CODE OF PROFESSIONAL ETHICS Commitment to Professionalism and Diligence ...................................................................... Legal and Ethical Conduct and Conflict of Interest ............................................................... Integrity and Competence........................................................................................................... Court Orders and Testimony ..................................................................................................... Reasonable Evidential Basis for Opinions ............................................................................... Confidential Information ............................................................................................................ Complete Reporting of Material Matters .................................................................................. Professional Improvement .........................................................................................................
4.1002 4.1005 4.1009 4.1012 4.1014 4.1017 4.1022 4.1023
CFE CODE OF PROFESSIONAL STANDARDS CFE Code of Professional Standards ....................................................................................... 4.1101
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Fraud Examiners Manual: 2018 International Edition
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