Tag Archives: forensic accounting

The Healthcare Fraud Circus

The trade press indicates that healthcare expenditures are again on the rise while the ACFE tells us that approximately $25 million dollars per hour is stolen, wasted or abused in the provision of healthcare services in the US alone. Not surprisingly, our Chapter members, CFEs and forensic accountants, employed by both governmental and private institutions, are being increasingly called upon to grapple with the fallout.

The Centers for Medicare and Medicaid Services (CMS) defines healthcare fraud as the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). The Health Insurance Portability and Accountability Act (HIPAA) is more specific, defining the term federal healthcare offense as “a violation of, or a criminal conspiracy to violate” specific provisions of the U.S. Code, “if the violation or conspiracy relates to a health care benefit program” 18 U.S.C. § 24(a).

The statute goes on to define a health care benefit program as any public or private plan or contract, affecting commerce, under which any medical benefit, item, or service is provided to any individual, and includes any individual or entity who is providing a medical benefit, item, or service for which payment may be made under the plan or contract. Finally, health care fraud is defined as knowingly and willfully executing a scheme to defraud a healthcare benefit program or obtaining, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by. . . any healthcare benefit program. HIPAA establishes specific criminal sanctions for offenses against both private and public health insurance programs. These offenses are consistent with the common definitions of fraud in that they involve false statements, misrepresentations, or deliberate omissions that are critical to the determination of benefits payable and which may obstruct fraud investigations.

Practitioners new to fraud examination and forensic accounting in the healthcare arena need to develop a familiarity with the players involved in the provision of and payment for healthcare services if they are to effectively investigate identified instances of fraud, waste, and abuse in this ever-expanding sector of the economy.

Healthcare fraud differs from healthcare abuse. CMS says that abuse refers to incidents or practices that are not consistent with the standard of medical care (in other words, with substandard care)

–Unnecessary costs to a program, caused either directly or indirectly;
–Improper payment or payment for services that fail to meet professional standards;
–Medically unnecessary services;
–Substandard quality of care (e.g., in nursing homes);
–Failure to meet coverage requirements.

Healthcare fraud, in comparison, typically takes one or more of the following forms:

–False statements or claims;
–Elaborate schemes;
–Cover-up strategies;
–Misrepresentations of value;
–Misrepresentations of service.

It’s important to appreciate that healthcare is a dynamic and segmented market among parties that deliver or facilitate the delivery of health information, healthcare resources, and the financial transactions that underly and support the functioning of all the many components of the total business process. To fully appreciate what healthcare fraud looks like, it’s important to understand traditional and nontraditional players. The patient is the individual who actually receives a healthcare service. The provider is an individual or entity that delivers or executes the healthcare service. The payer is the entity that processes the financial transaction. The plan sponsor is the party that funds the transaction. Plan sponsors include private self-insurance programs, employer-based premium programs, and government programs such as Medicare and Medicaid. A vendor is any entity that provides a professional service or materials used in the delivery of patient care. Complicating matters is that each one of these player entities has a distinct perspective and point of view of the overall process which can differ significantly from that of each of the others.

So, what does healthcare fraud look like from the individual patient’s perspective? The patient may submit a false claim with no participation from any other party. The patient may exaggerate a workers’ compensation claim or allege that an injury took place at work when in fact it occurred outside of work. The patient may participate in collusive fraudulent behavior with other parties. A second party may be a physician who fabricates a service for liability compensation. The patient may be involved in an established crime ring that involves extensive collusive behavior, such as staging an auto accident. The schemes typically repeat themselves as well as constantly evolve in the creativity they demonstrate.

And from the provider’s perspective? The fraud schemes can vary from simple false claims to complex financial arrangements. The traditional scheme of submitting false claims for services not rendered has always been and continues to be a problem. Other maneuvers, such as submitting duplicate claims or not acknowledging duplicate payments, are issues as well.

Some schemes manifest great complexity and sophistication in their understanding of payer systems. One example is the rent-a-patient scheme where criminals pay “recruiters” to organize and recruit beneficiaries to visit clinics owned or operated by the criminals. For a fee, recruiters “rent,” or “broker,” the beneficiaries to the criminals. Recruiters often enlist beneficiaries at low-income housing projects, retirement communities, or employment settings of low-income wage earners. Detecting complicated misrepresentations that involve contractual arrangements with third parties or cost report manipulations submitted to government programs requires a niche expertise for identification representing an opportunity for anti-fraud practitioners expert in data mining.

And from the payer’s perspective? The fraud schemes perpetrated by this group tend to be pursued mostly in response to transactions between the payer and a government plan sponsor. They include misrepresentations of performance guarantees, not answering beneficiary questions on claims status, bad-faith claim transactions, and financial transactions that are not contractually based. Other fraudulent activities include altering or reassigning the diagnosis or procedure codes submitted by the provider. Auditing payer activities also requires a niche expertise involving operational as well as contractual issues.

Healthcare fraud schemes perpetrated by employers include underreporting the number of employees, employee classifications, and payroll information; failing to pay insurance premiums, which results in no coverage; creating infrastructures that make employees pay for coverage via payroll deductions; engaging in management activities that discourage employees from seeking medical treatment; and referring employees to a medical facility and in turn receiving compensation for the referrals.

Vendor perpetrated schemes furnishes numerous examples involving a range of participants, from professional healthcare subcontractors to suppliers of equipment, products, services, and pharmaceuticals. These schemes include false claims, claims for altered products, counterfeit medications, and services from unlicensed professionals. They include collusive behavior among several entities as well as between individual professionals.

In summary, the take away for anti-fraud professionals is that Healthcare fraud is growing at an accelerated rate in the United States. Traditional schemes include false claim submissions, care that lacks medical necessity, controlled substance abuse, upcoding (billing for more expensive procedures), employee-plan fraud, staged-accident rings, waiver of copayments and deductibles, billing experimental treatments as nonexperimental ones, agent-broker fraud relationships, premium fraud, bad-faith claim payment activities, quackery; overutilization (rendering more services than are necessary), and kickbacks. Evolved schemes include complex rent-a-patient activities, 340 B program abuse activities (setting aside discounted drugs, making them unavailable to those in need), pill-mill schemes (schemes to falsely bill prescriptions), counterfeit drug activities, and organized criminal schemes.

CFEs and forensic accountants have a significant role in combating all of this. The good news is that much information is available to guide practitioners from both governmental and private sources.

Concealment Strategies & Fraud Scenarios

I remember Joseph Wells mentioning at an ACFE conference years ago that identifying the specific asset concealment strategy selected by a fraudster was often key to the investigator’s subsequent understanding of the entire fraud scenario the fraudster had chosen to implement. What Joe meant was that a fraud scenario is the unique way the inherent fraud scheme has occurred (or can occur) at an examined entity; therefore, a fraud scenario describes how an inherent fraud risk will occur under specific circumstances. Upon identification, a specific fraud scenario, and its associated concealment strategy, become the basis for fraud risk assessment and for the examiner’s subsequent fraud examination program.

Fraud concealment involves the strategies used by the perpetrator of the fraud scenario to conceal the true intent of his or her transaction(s). Common concealment strategies include false documents, false representations, false approvals, avoiding or circumventing control levels, internal control evasion, blocking access to information, enhancing the effects of geographic distance between documents and controls, and the application of both real and perceived pressure. Wells also pointed out that an important aspect of fraud concealment pertains to the level of sophistication demonstrated by the perpetrator; the connection between concealment strategies and fraud scenarios is essential in any discussion of fraud risk structure.

As an example, consider a rights of return fraud scenario related to ordered merchandise. Most industries allow customers to return products for any number of reasons. Rights of return refers to circumstances, whether as a matter of contract or of existing practice, under which a product may be returned after its sale either in exchange for a cash refund, or for a credit applied to amounts owed or to be owed for other products, or in exchange for other products. GAAP allows companies to recognize revenue in certain cases, even though the customer may have a right of return. When customers are given a right of return, revenue may be recognized at the time of sale if the sales price is substantially fixed or determinable at the date of sale, the buyer has paid or is obligated to pay the seller, the obligation to pay is not contingent on resale of the product, the buyer’s obligation to the seller does not change in the event of theft or physical destruction or damage of the product, the buyer acquiring the product for resale is economically separate from the seller, the seller does not have significant obligations for future performance or to bring about resale of the product by the buyer, and the amount of future returns can be reasonably estimated.

Sales revenue not recognizable at the time of sale is recognized either once the return privilege has substantially expired or if the conditions have been subsequently met. Companies sometimes stray by establishing accounting policies or sales agreements that grant customers vague or liberal rights of returns, refunds, or exchanges; that fail to fix the sales price; or that make payment contingent upon resale of the product, receipt of funding from a lender, or some other future event. Payment terms that extend over a substantial portion of the period in which the customer is expected to use or market the purchased products may also create problems. These terms effectively create consignment arrangements, because, no economic risk has been transferred to the purchaser.

Frauds in connection with rights of return typically involve concealment of the existence of the right, either by contract or arising from accepted practice, and/or departure from GAAP specified conditions. Concealment usually takes one or more of the following forms:

• Use of side letters: created and maintained separate and apart from the sales contract, that provide the buyer with a right of return;

• Obligations by oral promise or some other form of understanding between seller and buyer that is honored as a customary practice but arranged covertly and hidden;

• Misrepresentations designed to mischaracterize the nature of arrangements, particularly in respect of:

–Consignment arrangements made to appear to be final sales;

–Concealment of contingencies, under which the buyer can return the products, including failure to resell the products, trial periods, and product performance conditions;

–Failure to disclose the existence, or extent, of stock rotation rights, price protection concessions, or annual returned-goods limitations;

–Arrangement of transactions, with straw counterparties, agents, related parties, or other special purpose entities in which the true nature of the arrangements is concealed or obscured, but, ultimately, the counterparty does not actually have any significant economic risk in the “sale”.

Sometimes the purchaser is complicit in the act of concealment, for example, by negotiating a side letter, and this makes detection of the fraud even more difficult. Further, such frauds often involve collusion among several individuals within an organization, such as salespersons, their supervisors, and possibly both marketing and financial managers.

It’s easy to see that once a CFE has identified one or more of these concealment strategies as operative in a given entity, the process of developing a descriptive fraud scenario, completing a related risk assessment and constructing a fraud examination program will be a relatively straight forward process. As a working example, of a senario and related concealment strategies …

Over two decades ago the SEC charged a major computer equipment manufacturer with overstating revenue in the amount of $500,000 on transactions for which products had been shipped, but for which, at the time of shipment, the company had no reasonable expectation that the customer would accept and pay for the products. The company eventually accepted back most of the product as sales returns during the following quarter.

The SEC noted that the manufacturer’s written distribution agreements generally allowed the distributor wide latitude to return product to the company for credit whenever the product was, in the distributor’s opinion, damaged, obsolete, or otherwise unable to be sold. According to the SEC, in preparing the manufacturer’s financial statements for the target year, company personnel submitted a proposed allowance for future product returns that was unreasonably low in light of the high level of returns the manufacturer had received in the first several months of the year.

The SEC determined that various officers and employees in the accounting and sales departments knew the exact amount of returns the company had received before the year end, when the company’s independent auditors finished their fieldwork on the annual audit. Had the manufacturer revised the allowance for sales returns to reflect the returns information, the SEC concluded it would have had to reduce the net revenue reported for the fiscal year. Instead, the SEC found that several of the manufacturer’s officers and employees devised schemes to prevent the auditors from discovering the true amount of the returns, including 1), keeping the auditors away from the area at the manufacturer’s headquarters where the returned goods were stored, and 2), accounting personnel altering records in the computer system to reduce the level of returns. After all the facts were assembled, the SEC took disciplinary action against several company executives.

As with side agreements, a broad base of inquiry into company practices may be one of the best assessment techniques the CFE has regarding possible concealment strategies supporting fraud scenarios involving returns and exchanges. In addition to inquiries of this kind, the ACFE recommends that CFE’s may consider using analytics like:

• Compare returns in the current period with prior periods and ask about unusual increases.

• Because companies may slow the return process to avoid reducing sales in the current period, determine whether returns are processed in timely fashion. The facts can also be double-checked by confirming with customers.

• Calculate the sales return percentage (sales returns divided by total sales) and ask about any unusual increase.

• Compare returns after a reporting period with both the return reserve and the monthly returns to determine if they appear reasonable.

• Determine whether sales commissions are paid at the time of sale or at the time of collection. Sales commissions paid at the time of sale provide incentives to inflate sales artificially to meet internal and external market pressures.

• Determine whether product returns are adjusted from sales commissions. Sales returns processed through the so-called house account may provide a hidden mechanism to inflate sales to phony customers, collect undue commissions, and return the product to the vendor without being penalized by having commissions adjusted for the returned goods.

Fraud Prevention Oriented Data Mining

One of the most useful components of our Chapter’s recently completed two-day seminar on Cyber Fraud & Data Breaches was our speaker, Cary Moore’s, observations on the fraud fighting potential of management’s creative use of data mining. For CFEs and forensic accountants, the benefits of data mining go much deeper than as just a tool to help our clients combat traditional fraud, waste and abuse. In its simplest form, data mining provides automated, continuous feedback to ensure that systems and anti-fraud related internal controls operate as intended and that transactions are processed in accordance with policies, laws and regulations. It can also provide our client managements with timely information that can permit a shift from traditional retrospective/detective activities to the proactive/preventive activities so important to today’s concept of what effective fraud prevention should be. Data mining can put the organization out front of potential fraud vulnerability problems, giving it an opportunity to act to avoid or mitigate the impact of negative events or financial irregularities.

Data mining tests can produce “red flags” that help identify the root cause of problems and allow actionable enhancements to systems, processes and internal controls that address systemic weaknesses. Applied appropriately, data mining tools enable organizations to realize important benefits, such as cost optimization, adoption of less costly business models, improved program, contract and payment management, and process hardening for fraud prevention.

In its most complex, modern form, data mining can be used to:

–Inform decision-making
–Provide predictive intelligence and trend analysis
–Support mission performance
–Improve governance capabilities, especially dynamic risk assessment
–Enhance oversight and transparency by targeting areas of highest value or fraud risk for increased scrutiny
–Reduce costs especially for areas that represent lower risk of irregularities
–Improve operating performance

Cary emphasized that leading, successful organizational implementers have tended to take a measured approach initially when embarking on a fraud prevention-oriented data mining initiative, starting small and focusing on particular “pain points” or areas of opportunity to tackle first, such as whether only eligible recipients are receiving program funds or targeting business processes that have previously experienced actual frauds. Through this approach, organizations can deliver quick wins to demonstrate an early return on investment and then build upon that success as they move to more sophisticated data mining applications.

So, according to ACFE guidance, what are the ingredients of a successful data mining program oriented toward fraud prevention? There are several steps, which should be helpful to any organization in setting up such an effort with fraud, waste, abuse identification/prevention in mind:

–Avoid problems by adopting commonly used data mining approaches and related tools.

This is essentially a cultural transformation for any organization that has either not understood the value these tools can bring or has viewed their implementation as someone else’s responsibility. Given the cyber fraud and breach related challenges faced by all types of organizations today, it should be easier for fraud examiners and forensic accountants to convince management of the need to use these tools to prevent problems and to improve the ability to focus on cost-effective means of better controlling fraud -related vulnerabilities.

–Understand the potential that data mining provides to the organization to support day to day management of fraud risk and strategic fraud prevention.

Understanding, both the value of data mining and how to use the results, is at the heart of effectively leveraging these tools. The CEO and corporate counsel can play an important educational and support role for a program that must ultimately be owned by line managers who have responsibility for their own programs and operations.

–Adopt a version of an enterprise risk management program (ERM) that includes a consideration of fraud risk.

An organization must thoroughly understand its risks and establish a risk appetite across the enterprise. In this way, it can focus on those area of highest value to the organization. An organization should take stock of its risks and ask itself fundamental questions, such as:

-What do we lose sleep over?
-What do we not want to hear about us on the evening news or read about in the print media or on a blog?
-What do we want to make sure happens and happens well?

Data mining can be an integral part of an overall program for enterprise risk management. Both are premised on establishing a risk appetite and incorporating a governance and reporting framework. This framework in turn helps ensure that day-to-day decisions are made in line with the risk appetite, and are supported by data needed to monitor, manage and alleviate risk to an acceptable level. The monitoring capabilities of data mining are fundamental to managing risk and focusing on issues of importance to the organization. The application of ERM concepts can provide a framework within which to anchor a fraud prevention program supported by effective data mining.

–Determine how your client is going to use the data mined information in managing the enterprise and safeguarding enterprise assets from fraud, waste and abuse.

Once an organization is on top of the data, using it effectively becomes paramount and should be considered as the information requirements are being developed. As Cary pointed out, getting the right data has been cited as being the top challenge by 20 percent of ACFE surveyed respondents, whereas 40 percent said the top challenge was the “lack of understanding of how to use analytics”. Developing a shared understanding so that everyone is on the same page is critical to success.

–Keep building and enhancing the application of data mining tools.

As indicated above, a tried and true approach is to begin with the lower hanging fruit, something that will get your client started and will provide an opportunity to learn on a smaller scale. The experience gained will help enable the expansion and the enhancement of data mining tools. While this may be done gradually, it should be a priority and not viewed as the “management reform initiative of the day. There should be a clear game plan for building data mining capabilities into the fiber of management’s fraud and breach prevention effort.

–Use data mining as a tool for accountability and compliance with the fraud prevention program.

It is important to hold managers accountable for not only helping institute robust data mining programs, but for the results of these programs. Has the client developed performance measures that clearly demonstrate the results of using these tools? Do they reward those managers who are in the forefront in implementing these tools? Do they make it clear to those who don’t that their resistance or hesitation are not acceptable?

–View this as a continuous process and not a “one and done” exercise.

Risks change over time. Fraudsters are always adjusting their targets and moving to exploit new and emerging weaknesses. They follow the money. Technology will continue to evolve, and it will both introduce new risks but also new opportunities and tools for management. This client management effort to protect against dangers and rectify errors is one that never ends, but also one that can pay benefits in preventing or managing cyber-attacks and breaches that far outweigh the costs if effectively and efficiently implemented.

In conclusion, the stark realities of today’s cyber related challenges at all levels of business, private and public, and the need to address ever rising service delivery expectations have raised the stakes for managing the cost of doing business and conducting the on-going war against fraud, waste and abuse. Today’s client-managers should want to be on top of problems before they become significant, and the strategic use of data mining tools can help them manage and protect their enterprises whilst saving money…a win/win opportunity for the client and for the CFE.

Every Seat Taken!

Our Chapter’s thanks to all our attendees and to our partners, the Virginia State Police and national ACFE for the unqualified success of our May training event, Cyberfraud and Data Breaches! Our speaker, Cary Moore, CFE, CISSP, conducted a fully interactive, two-day session on one of the most challenging and relevant topics confronting practicing fraud examiners and forensic accountants today.

The event examined the potential avenues of data loss and guided attendees through the crucial strategies needed to mitigate the threat of malicious data theft and the risk of inadvertent data loss, recognizing that information is a valuable asset, and that management must take proactive steps to protect the organization’s intellectual property. As Cary forcefully pointed out, the worth of businesses is no longer based solely on tangible assets and revenue-making potential; the information the organization develops, stores, and collects accounts for a large share of its value.

A data breach occurs when there is a loss or theft of, or unauthorized access to, proprietary information that could result in compromising the data. It is essential that management understand the crisis its organization might face if its information is lost or stolen. Data breaches incur not only high financial costs but can also have a lasting negative effect on an organization’s brand and reputation.

Protecting information assets is especially important because the threats to such assets are on the rise, and the cost of a data breach increases with the number of compromised records. According to a 2017 study by the Ponemon Institute, data breaches involving fewer than 10,000 records caused an average loss of $1.9 million, while beaches with more than 50,000 compromised records caused an average loss of $6.3 million. However, before determining how to protect information assets, it is important to understand the nature of these assets and the many methods by which they can be breached.

Intellectual property is a catchall phrase for knowledge-based assets and capital, but it’s helpful to think of it as intangible proprietary information. Intellectual property (IP) is protected by law. IP law grants certain exclusive rights to owners of a variety of intangible assets. These rights incentivize individuals, company leaders, and investors to allocate the requisite resources to research, develop, and market original technology and creative works.

A trade secret is any idea or information that gives its owner an advantage over its competitors. Trade secrets are particularly susceptible to theft because they provide a competitive advantage. What constitutes a trade secret, however, depends on the organization, industry, and jurisdiction, but generally, to be classified as a trade secret, information must:

• Be secret: The information is not generally known to the relevant portion of the public.
• Confer some sort of economic benefit on its holder: The idea or information must give its owner an advantage over its competitors. The benefit conferred from the information, however, must stem from not being generally known, not just from the value of the information itself. The best test for determining what is confidential information is to determine whether the information would provide an advantage to the competition.
• Be the subject of reasonable efforts to maintain its secrecy: The owner must take reasonable steps to protect its trade secrets from disclosure. That is, a piece of information will not receive protection as a trade secret if the owner does not take adequate steps to protect it from disclosure.

Cary presented in-depth information on the various types of threats to data security including:

–Insiders
–Hackers
–Competitors
–Organized criminal groups
–Government-sponsored groups

Protecting proprietary information is a timely issue, but it is difficult. The event presented a list of common challenges faced when protecting information assets:

–Proprietary information is among the most valuable commodities, and attackers are doing everything in their power to steal as much of this information as possible.
–The risk of data breaches for organizations is high.
–New and emerging technologies create new risks and vulnerabilities.
— IT environments are becoming increasingly complex, making the management of them more expensive, difficult, and time consuming.
–There is a wider range of devices and access points, so businesses must proactively seek ways to combat the effects of this complexity.
–The rise in portable devices is creating more opportunities for data to “leak” from the business.
–The rise in Bring Your Own Device (BYOD) initiatives is generating new operational challenges and security problems.
–The rapidly expanding Internet of Things (IoT) has significantly increased the number of network connected things (e.g., HVAC systems, MRI machines, coffeemakers) that pose data security threats, many of which were inconceivable only a short time ago.
–The number of threats to corporate IT systems is on the rise.
–Malware is becoming more sophisticated.
–There is an increasing number of laws in this area, making information security an urgent priority.

Cary covered the entire gamut of challenges related to cyber fraud and data breaches ranging from legal issues, corporate espionage, social engineering, the use of social media, the bring-your-own-devices phenomenon, and the impact of cloud computing. The remaining portion of the event was devoted to addressing how enterprises can effectively respond when confronted by the challenges posed by these issues including breach response team building and breach prevention techniques like conducting security risk assessments, staff awareness training and the incident response plan.

When an organization experiences a data breach, management must respond in an appropriate and timely manner. During the initial response, time is critical. To help ensure that an organization responds to data breaches timely and efficiently, management should have an incident response plan in place that outlines how to respond to such issues. Timely responses can help prevent further data loss, fines, and customer backlash. An incident response plan outlines the actions an organization will take when data breaches occur. More specifically, a response plan should guide the necessary action when a data breach is reported or identified. Because every breach is different, a response plan should not outline how an organization should respond in every instance. Instead, a response plan should help the organization manage its response and create an environment to minimize risk and maximize the potential for success. In short, a response plan should describe the plan fundamentals that the organization can deploy on short notice.

Again, our sincere thanks go out to all involved in the success of this most worthwhile training event!

Expert Witness or Consultant

One of our newer Chapter members submitted a comment on-line two weeks ago requesting information about the pitfalls involved in the CFE choosing to act as a consultant to a client attorney rather than as an expert witness. This is an important topic for CFEs in individual practice as well as for those serving as examiners on the staffs of private or public entities. The ACFE tells us that CFEs typically act as experts in the legal process by assisting attorneys with the financial details of a suit and testifying about these practices at trial. They analyze documents and transactions, showing how the fraud was accomplished and, when possible, who the most likely perpetrators were. The CFE is a guide and adviser for the attorney in assembling the case, and a major participant in explaining the details of a fraud scenario to a judge and jury.

In general, expert witnesses are typically brought in when required by law, as in malpractice suits where a member of a given profession must explain the infraction against professional by-laws or principles; when key points are deemed sufficiently technical or complex, such as in cooking-the-books schemes involving intricate accounting manipulations, or to assist a jury in making its decision. Federal Rule of Evidence 702 says that an expert witness with appropriate knowledge and credentials may testify in any proceeding where scientific, technical, or specialized knowledge will shed light on the dispute. Even in cases that don’t go to trial, experts may still be involved in mediation, arbitration, settlement conferences, or summary judgment motions.

Experts contribute to the trial process in numerous ways. They provide background information to guide and frame a case; during the discovery process they investigate, run tests, advise on depositions, prepare other witnesses, make exhibits, and respond to the opposition’s discovery requests; they file written opinions, which are entered as evidence into the court record; and they testify in actual proceedings should the case make it to a courtroom.

Once they accept a case, many experts immediately start assembling a narrative version of the events. This detailed summary of the facts of the case serves as the raw material for rendering an official opinion. As we’ve pointed out many times, it’s important that the text be written with care and professionalism because the text may (and probably will) have to be produced during discovery. Additionally, a well-written narrative helps the client attorney in preparing and executing the case at trial.

According to our most experienced members, perhaps the thorniest challenge for CFEs, once they’re engaged to work on a case, is setting a value on the specific business losses due to a fraud. Depending on the facts, there may be several methods for evaluating net worth/net loss, each rendering a different number at the end. And regardless of the numbers, there’s always the human element. Calculating business loss is a challenging task in a complex case because the examiner has to consider the amount of business being done, try to reconstruct the market conditions, think about competitors, and then calculate the amount of direct personal benefit; all of these factors being intertwined. In such cases, the examiner must consider a variety of points, prepare an estimate of loss, and then, most often, try to work out a compromise.

Article V. of the Association of Certified Fraud Examiners Code of Professional Ethics states:

A fraud examiner, in conducting examinations, will obtain evidence or other documentation to establish a reasonable basis for any opinion rendered. No opinion shall be expressed regarding the guilt or innocence of any person or party.

The rule that prohibits opinions regarding the guilt or innocence of any person or party is a rule of prudence. Clearly, it’s prudent for a Certified Fraud Examiner to refrain from usurping the role of jury. In a courtroom, no good attorney would ask a CFE for such a conclusion, and no alert judge would allow such testimony.  The fraud examiner’s job is to present the evidence in his or her report. Such evidence might constitute a convincing case pointing to the guilt or innocence of a person. But a clear line should be drawn between a report that essentially says, “Here is the evidence” and one that steps over the line and says “S/he is the guilty (innocent) person.” Nevertheless, there is a fine line between recommending action, forwarding the evidence to a law enforcement agency or filing a complaint or lawsuit, and giving an opinion on guilt or innocence. CFEs may make such recommendations because they think the evidence is strong enough to support a case. They might even have a conclusion about whether the suspect committed a crime. The rule does not prohibit the CFE, under the proper circumstances, from accusing the person under investigation. However, the ultimate decision of whether a person is “guilty” or “innocent” is for a jury to determine. The CFE is free to report the facts and the conclusions that can be drawn from those facts, but the decision as to whether a person is guilty of a crime is a decision for the judge or jury.

Caution is the by-word for every expert witnesses at every step of the legal process. According to discovery rules governing expert testimony, everything the expert says or writes about the case after being hired is subject to discovery by opposing counsel. That means everything: narrative versions of the case, comments to the press or law enforcement, hypothetical reconstructions, even notes can be demanded and used by the opposing party. A shrewd attorney can use an expert’s preliminary notes containing drafts of an opinion and other purely deliberative information to call the witness’s testimony into question. The only exception is when the expert is hired by the attorney purely on a consulting basis. An expert witness has no privilege. The principle of privilege exists to protect certain core societal relationships (attorney-client, husband-wife), but the expert witness’s relationship with clients is not among those protected. If the expert’s opinions will be presented in court, everything related to the expert’s opinion is discoverable by the defense.

There is an exception. The CFE expert may consult on the client attorney’s work product, i.e., materials the attorney prepares as background for a case. While performing background work, the expert is said to be working as an associate of the attorney, so the exchange is protected; they are two professionals conferring. However, once the expert is hired as a witness, and begins entering opinions as part of the attorney’s case, there is no privilege for any contribution the expert makes. The distinction is something like this: when acting as “witnesses,” experts are bringing official information to the court, and so must disclose any contact with the case; when experts act as “consultants” or “associates” for attorneys or law enforcement, they are only assisting the attorney, and do not have to disclose their involvement in the case. However, if a testifying expert reviews the work of the consultant expert, then the work of the consultant expert will be discoverable. Remember this; if a CFE is hired to testify at trial, anything he or s/he used to form his or her opinion will be subject to review by the opposing party. This includes notes from other experts, documents received from the plaintiff or defendant, and any documents or notes from the attorney. CFEs should be sure to consult with the client attorney before reviewing anything. If the attorney has not given the document to you, then ask before you read. Otherwise, you may inadvertently destroy the confidentiality or privilege of the material.

In summary, the best way to protect the confidentiality of information is to keep good files. Any materials which serve as the basis for an expert’s opinion must be in the file. Notes, documents, or tests that serve as background, or that represent unfruitful lines of investigation, don’t have to be included, and probably shouldn’t be. The attorney trying the case doesn’t want an expert having to answer about investigative dead ends or exploratory side lines; a shrewd cross-examiner can turn a hastily scribbled hypothetical into reasonable doubt, just enough to avert a conviction. So, in the best-case scenario, an expert presents to the court an opinion and its basis, nothing more nothing less.

Finding the Words

I had lunch with a long-time colleague the other day and the topic of conversation having turned to our May training event next week, he commented that when conducting a fraud examination, he had always found it helpful to come up with a list of words specifically associated with the type of fraud scenario on which he was working.  He found the exercise useful when scanning through the piles of textual material he frequently had to plow through during complex examinations.

Data analysis in the traditional sense involves running rule-based queries on structured data, such as that contained in transactional databases or financial accounting systems. This type of analysis can yield valuable insight into potential frauds. But, a more complete analysis requires that fraud examiners (like my friend) also consider unstructured textual data. Data are either structured or unstructured. Structured data is the type of data found in a database, consisting of recognizable and predictable structures. Examples of structured data include sales records, payment or expense details, and financial reports. Unstructured data, by contrast, is data that would not be found in a traditional spreadsheet or database. It is typically text based.

Our client’s employees are sending and receiving more email messages each year, retaining ever more electronic source documents, and using more social media tools. Today, we can anticipate unstructured data to come from numerous sources, including:

• Social media posts
• Instant messages
• Videos
• Voice files
• User documents
• Mobile phone software applications
• News feeds
• Sales and marketing material
• Presentations

Textual analytics is a method of using software to extract usable information from unstructured text data. Through the application of linguistic technologies and statistical techniques, including weighted fraud indicators (e.g., my friend’s fraud keywords) and scoring algorithms, textual analytics software can categorize data to reveal patterns, sentiments, and relationships indicative of fraud. For example, an analysis of email communications might help a fraud examiner gauge the pressures/incentives, opportunities, and rationalizations to commit fraud that exist in a client organization.

According to my colleague, as a prelude to textual analytics (depending on the type of fraud risk present in a fraud examiner’s investigation), the examiner  will frequently profit by coming up with a list of fraud keywords that are likely to point to suspicious activity. This list will depend on the industry of the client, suspected fraud schemes, and the data set the fraud examiner has available. In other words, if s/he is running a search through journal entry detail, s/he will likely search for different fraud keywords than if s/he were running a search of emails. It might be helpful to look at the ACFE’s fraud triangle when coming up with a keyword list. The factors identified in the triangle are helpful when coming up with a fraud keyword list. Consider how someone in the entity under investigation might have the opportunity to commit fraud, be under pressure to commit fraud, or be able to rationalize the commission of fraud.

Many people commit fraud because of something that has happened in their life that motivates them to steal. Maybe they find themselves in debt, or perhaps they must meet a certain goal to qualify for a performance-based bonus. Keywords that might indicate pressure include deadline, quota, trouble, short, problem, and concern. Think of words that would indicate that someone has the opportunity or ability to commit fraud. Examples include override, write-off, recognize revenue, adjust, discount, and reserve/provision.

Since most fraudsters do not have a criminal background, justifying their actions is a key part of committing fraud. Some keywords that might indicate a fraudster is rationalizing his actions include reasonable, deserve, and temporary.

So, even though the concepts embodied in the fraud triangle are a good place to start when developing a keyword list, it’s also important to consider the nature of the client entity’s industry and the types of payments it makes or is suspected of making. Think about the fraud scenarios that are likely to have occurred. Does the entity do a significant amount of work overseas or have many contractors? If so, there might be an elevated risk of bribery. Focus on the payment text descriptions in journal entries or in work delated documentation, since no one calls it “bribe expense.” Some examples of word combinations in payment descriptions that might merit special attention include:

• Goodwill payment
• Consulting fee
• Processing fee
• Incentive payment
• Donation
• Special commission
• One-time payment
• Special payment
• Friend fee
• Volume contract incentive

Any payment descriptions bearing these, or similar terms warrant extra scrutiny to check for reasonableness. Also, examiners should always be wary of large cash disbursements that have a blank journal payment description.

Beyond key word lists, the ACFE tells us that another way to discover fraud clues hidden in text is to consider the emotional tone of employee correspondence. In emails and instant messages, for instance, a fraud examiner should identify derogatory, surprised, secretive, or worried communications. In one example, former Enron CEO Ken Lay’s emails were analyzed, revealing that as the company came closer to filing bankruptcy, his email correspondence grew increasingly derogatory, confused, and angry. This type of analysis provided powerful evidence that he knew something was wrong at the company.

While advanced textual analytics can be extremely revealing and can provide clues for potential frauds that might otherwise go unnoticed, the successful application of such analytics requires the use of sophisticated software, as well as a thorough understanding of the legal environment of employee rights and workplace searches. Consequently, fraud examiners who are considering adding textual analytics to their fraud detection arsenal should consult with technological and legal experts before undertaking such techniques.

Even with sophisticated data analysis techniques, some data are so vast or complex that they remain difficult to analyze using traditional means. Visually representing data via graphs,  link diagrams, time-series charts, and other illustrative representations can bring clarity to a fraud examination. The utility of visual representations is enhanced as data grow in volume and complexity. Visual analytics build on humans’ natural ability to absorb a greater volume of information in visual rather than numeric form and to perceive certain patterns, shapes, and shades more easily than others.

Link analysis software is used by fraud examiners to create visual representations (e.g., charts with lines showing connections) of data from multiple data sources to track the movement of money; demonstrate complex networks; and discover communications, patterns, trends, and relationships. Link analysis is very effective for identifying indirect relationships and relationships with several degrees of separation. For this reason, link analysis is particularly useful when conducting a money laundering investigation because it can track the placement, layering, and integration of money as it moves around unexpected sources. It could also be used to detect a fictitious vendor (shell company) scheme. For instance, the investigator could map visual connections between a variety of entities that share an address and bank account number to reveal a fictitious vendor created to embezzle funds from a company.  The following are some other examples of the analyses and actions fraud examiners can perform using link analysis software:

• Associate communications, such as email, instant messages, and internal phone records, with events and individuals to reveal connections.
• Uncover indirect relationships, including those that are connected through several intermediaries.
• Show connections between entities that share an address, bank account number, government identification number (e.g., Social Security number), or other characteristics.
• Demonstrate complex networks (including social networks).

Imagine a listing of vendors, customers, employees, or financial transactions of a global company. Most of the time, these records will contain a reference to a location, including country, state, city, and possibly specific street address. By visually analyzing the site or frequency of events in different geographical areas, a fraud investigator has yet another variable with which s/he can make inferences.

Finally, timeline analysis software aids fraud examiners in transforming their data into visual timelines. These visual timelines enable fraud examiners to:

• Highlight key times, dates, and facts.
• More readily determine a sequence of events.
• Analyze multiple or concurrent sequences of events.
• Track unaccounted for time.
• Identify inconsistencies or impossibilities in data.

The Client Requested Recommendation

We fraud examiners must be very circumspect about drawing conclusions. But who among us has not found him or herself in a discussion with a corporate counsel who wants a recommendation from us about how best to prevent the occurrence of a fraud in the future?  In most situations, the conclusions from a well conducted examination should be self-evident and should not need to be pointed out in the report. If the conclusions are not obvious, the report might need to be clarified. Our job as fraud examiners is to obtain sufficient relevant and reliable evidence to determine the facts with a reasonable degree of forensic certainty. Assuming facts without obtaining sufficient relevant and reliable evidence is generally inappropriate.

Opinions regarding technical matters, however, are permitted if the fraud examiner is qualified as an expert in the matter being considered (many fraud examiners are certified not only as CFE’s but also as CPA’s, CIA’s or CISA’s).  For example, a permissible expert opinion, and accompanying client requested recommendation, might address the relative adequacy of an entity’s internal controls. Another opinion (and accompanying follow-on recommendation) might discuss whether financial transactions conform to generally accepted accounting principles. So, recommended remedial measures to prevent future occurrences of similar frauds are also essentially opinions, but are acceptable in fraud examination reports.

Given that examiners should always be cautious in complying with client examination related requests for recommendations regarding future fraud prevention, there is no question that such well-considered recommendations can greatly strengthen any client’s fraud prevention program.  But requested recommendations can also become a point of contention with management, as they may suggest additional procedures for staff or offend members of management if not presented sensitively and correctly. Therefore, examiners should take care to consider ways of follow-on communication with the various effected stakeholders as to how their recommendations will help fix gaps in fraud prevention and mitigate fraud risks.  Management and the stakeholders themselves will have to evaluate whether the CFE’s recommendations being provided are worth the investment of time and resources required to implement them (cost vs. benefit).

Broadly, an examination recommendation (where included in the final report or not) is either a suggestion to fix an unacceptable scenario or a suggestion for improvement regarding a business process.  At management’s request, fraud examination reports can provide recommendations to fix unacceptable fraud vulnerabilities because they are easy to identify and are less likely to be disputed by the business process owner. However, recommendations to fix gaps in a process only take the process to where it is expected to be and not where it ideally could be. The value of the fraud examiner’s solicited recommendation can lie not only in providing solutions to existing vulnerability issues but in instigating thought-provoking discussions.  Recommendations also can include suggestions that can move the process, or the department being examined to the next level of anti-fraud efficiency.  When recommendations aimed at future prevention improvements are included, examination reports can become an additional tool in shaping the strategic fraud prevention direction of the client being examined.

An examiner can shape requested recommendations for fraud prevention improvement using sources both inside and outside the client organization. Internal sources of recommendations require a tactful approach as process owners may not be inclined to share unbiased opinions with a contracted CFE, but here, corporate counsel can often smooth the way with a well-timed request for cooperation. External sources include research libraries maintained by the ACFE, AICPA and other professional organizations.

It’s a good practice, if you expect to receive a request for improvement recommendations from management, to jot down fraud prevention recommendation ideas as soon as they come to mind, even though they may or may not find a place in the final report. Even if examination testing does not result in a specific finding, the CFE may still recommend improvements to the general fraud prevention process.

If requested, the examiner should spend sufficient time brainstorming potential recommendations and choosing their wording carefully to ensure their audience has complete understanding. Client requested recommendations should be written simply and should:

–Address the root cause if a control deficiency is the basis of the fraud vulnerability;
–Address the business process rather than a specific person;
–Include bullets or numbering if describing a process fraud vulnerability that has several steps;
–Include more than one way of resolving an issue identified in the observation, if possible. For example, sometimes a short-term manual control is suggested as an immediate fix in addition to a recommended automated control that will involve considerable time to implement;
–Position the most important observation or fraud risk first and the rest in descending order of risk;
–Indicate a suggested priority of implementation based on the risk and the ease of implementation;
–Explain how the recommendation will mitigate the fraud risk or vulnerability in question;
–List any recommendations separately that do not link directly to an examination finding but seek to improve anti-fraud processes, policies, or systems.

The ACFE warns that recommendations, even if originally requested by client management, will go nowhere if they turn out to be unvalued by that management. Therefore, the process of obtaining management feedback on proposed anti-fraud recommendations is critical to make them practical. Ultimately, process owners may agree with a recommendation, agree with part of the recommendation, and agree in principle, but technological or personnel resource constraints won’t allow them to implement it.  They also may choose to revisit the recommendation at a future date as the risk is not imminent or disagree with the recommendation because of varying perceptions of risk or mitigating controls.

It’s my experience that management in the public sector can be averse to recommendations because of public exposure of their reports. Therefore, CFEs should clearly state in their reports if their recommendations do not correspond to any examination findings but are simply suggested improvements. More proposed fraud prevention recommendations do not necessarily mean there are more faults with the process, and this should be communicated clearly to the process owners.

Management responses should be added to the recommendations with identified action items and implementation timelines whenever possible. Whatever management’s response, a recommendation should not be changed if the response tends to dilute the examiner’s objectivity and independence and becomes representative of management’s opinions and concerns. It is the examiner’s prerogative to provide recommendations that the client has requested, regardless of whether management agrees with them. Persuasive and open-minded discussions with the appropriate levels of client management are important to achieving agreeable and implementable requested fraud prevention recommendations.

The journey from a client request for a fraud prevention recommendation to a final recommendation (whether included in the examination report or not) is complex and can be influenced by every stakeholder and constraint in the examination process, be it the overall posture of the organization toward change in general, its philosophy regarding fraud prevention, the scope of the individual fraud examination itself, views  of the effected business process owner, experience and exposure of the examination staff, or available technology. However, CFEs understand that every thought may add value to the client’s fraud prevention program and deserves consideration by the examination team. The questions at the end of every examination should be, did this examination align with the organization’s anti-fraud strategy and direction? How does our examination compare with the quality of practice as seen elsewhere? And finally, to what degree have the fraud prevention recommendations we were asked to make added value?

The Ideal Employee

It was late on a dark November evening in 2002 when the corporate counsel of the Victoria Paper Corporation contacted our Chapter member Jay Magret, CFE, CIA about a suspected irregularity involving the team of Tim Clark, the world-wide maintenance manager for Victoria’s most complex automated paper manufacturing equipment.

Clark had been hired after a long exhaustive search by one of Victoria’s many employment contractors, Global Image, Inc. Clark was hired to oversee the entire maintenance program at Victoria’s plants worldwide.  Victoria’s management was elated because Clark seemed ideal for the position, seemingly having spent half of his professional life providing automated systems savvy support to major paper companies around the world. He was used to working in foreign locals and had collected an array of impressive skills that enabled him to be appreciated as a through professional. Once hired, Tim requested four additional staff members for his unit, whom he said he personally knew, and contracted for through Global Image. The names and resumes of the four new staff members were subsequently provided by Grayson Employment, another job agency that also specialized in providing labor to the paper industry. Because the four new staff members were already registered in Grayson’s employee database and were explicitly requested by Tim Clark, Victoria and Global Image didn’t feel the need to complete the usual background verifications.

Such a chain of job agencies is common in the labor market: international paper companies, like companies in other industries, manage large projects in disparate, sometimes isolated locales around the globe, and they are stressed by production deadlines. Accordingly, companies find themselves continuously short on the highly specialized people who are qualified to manage and support such projects. Such international companies rely heavily on job agencies to provide contractors already skilled in the business and available to work in remote destinations.

When a business sector is booming, it becomes crowded with personnel interested in exploiting opportunity and, in the resulting complicated labor market, the temptation to cut personnel supply corners in response to tight deadlines often emerges. The result is that, with a plethora of job agencies providing labor, sometimes to a single project, the final employer sometimes doesn’t know with precision what the hourly fee paid to each individual contractor is after it is redistributed along the chain of multiple job agencies.

Under Clark’s direction, his team was charged with the ambitious task of assuring the continuous performance of maintenance activities at Victoria’s paper plants around the world. On paper, Clark’s team worked long hours each week and most weekends, sometimes flying throughout Europe and Asia with little rest. Each hour worked by a member of the maintenance team was certified and signed off on personally by Clark, on behalf of Victoria.

During their year-and-a-half of service, the four individuals hired by Tim Clark claimed to have worked an excessive number of hours, which triggered an internal review by Grayson Employment’s personnel management. During their review, personnel management found that the four employees’ employment files did not include appropriate identification documents. When the agency requested copies of their passports, the four employees immediately submitted their resignations, and soon after Clark did the same. The day after Clark resigned, Grayson contacted Victoria whose corporate counsel, alarmed, contacted our Jay Magret.

Setting to work immediately and working closely with Victoria’s auditors and the corporate counsel, Magret quickly uncovered evidence that Clark had falsified records and documents for three of the individuals on his team. It became apparent to Jay that those individuals were ghost employees; they did not exist. Clark had created fake resumes for three ghost employees, falsified contracts, signed time sheets, and forged the resignation letters. Further analysis showed that the fourth individual did indeed exist, was related to Clark, and had collaborated on the scheme. Clark and his accomplice had to work hard to carry out the duties of four employees.

Jay’s analysis also showed that Omega’s employee interviews were sometimes conducted solely by line managers involved in the hiring process, without the support of the Human Resources Department. The same line managers were then responsible for certifying the time sheets of their employees, including contractors, while their identification documents weren’t systematically collected or retained. Moreover, the contracts and procedures in use didn’t clearly establish or document each step of the selection and job assignment process.

Magret’s final report specified that the fraud was possible, and profitable, because the paper company client paid the wages of each ghost employee through the chain of job agencies and directly into the accounts of the contractors, which were registered in the name of a private company and managed by Clark. By the time Victoria realized the scope of the fraud scenario with Magret’s help, Clark and his associate had already disappeared with more than a million dollars paid to them during their year-and-a-half scheme. The paper company later discovered that even Clark was not who he claimed to be. He had used a fake identity and was untraceable, leaving little to no chance of recovery of the stolen money.

In response to management’s request that he proactively suggest controls to strengthen Victoria’s anti-fraud program, Magret suggested, as a matter of normal practice, that:

–Companies should perform time assessments to ensure they know how long a job will take to complete.

–Strict procedures should be in place during the hiring process, especially regarding segregation of duties. Human resources should always be involved in the process and responsible for checking identification documents with the physical person.

–The company should limit the opportunity for line managers to recommend hiring people they know. In some cases, it is unavoidable, so managers should always try to guarantee a higher level of segregation, especially in the authorization of time sheets.

–When using a job agency, the company should be sure that the relationship with contractors will be directly between the company itself and the agency. By doing this, the company will save money and be more assured about the contracted personnel.

— Client inhouse auditors of the personnel function should perform a periodic analysis of office records by selecting a sample of employees and verifying their effective presence in the office or on the job site, making sure appropriate identification is included in their records.
–Excessive hours claimed is as a red flag, especially when it is common among off-site employees. Establishing key performance indicators for each department or business process can serve as a reference for red flag comparisons.

–A wide-ranging and fragmented work environment can make the ghost employee phenomenon possible. A strong internal control framework and strictly enforced personnel policies are the only ways to prevent and discourage this type of fraud scheme.

Confidential Sources & Informants

There has been much in the news recently concerning the confidential sources and informants involved in current Federal on-going criminal and non-criminal investigations.  During the more complex of our examinations, we, as practicing fraud examiners and forensic accountants, can also expect to encounter the same types of sources and informants. Both sources and informants serve the same purpose, to provide information helpful in the development of a case. However, there are notable differences between confidential sources and confidential informants; the two terms should not be used interchangeably.

A confidential source furnishes information simply consequent on being a member of an occupation or profession and has no culpability in the alleged offense. For example, confidential sources might include barbers, attorneys, accountants, and law enforcement personnel. A confidential informant on the other hand has a direct or indirect involvement in the matter under investigation, and s/he might (incidentally) also be culpable. The distinction between the two sources is their involvement or noninvolvement in the offense. As every CFE knows, informants can pose treacherous legal issues for the fraud examiner.

There is no question that information provided by a well-placed informant can be invaluable to any case; secretly photographed or recorded conversations provided by an informant are the most convincing type of evidence. This information is generally viewed as something the use of which is sure to be successful for a criminal prosecutor, because there is little that a white-collar criminal can dispute when caught red-handed in the fraudulent act.

The ACFE identifies several types of informants with which a CFE might expect to become directly or indirectly involved: the basic lead, the participant, the covert, and the accomplice/witness.

—Basic Lead Informants. This type of informant supplies information to the investigator about illicit activities that they have encountered. The reasons that the informant decides to supply information are varied; some informants simply want to “do their part” to stop an unscrupulous activity, while others are interested in harming the criminals against whom they are informing. For instance, many informants in drug, prostitution, or illegal gambling endeavors are involved in those activities as well and intend to eliminate some of their competition. Whatever the reason, these informants’ only role in an investigation is to supply useful information.

—Participant informants.  The participant informant is directly involved in gathering preliminary evidence in the investigation. The informant in this instance not only supplies an investigation with information, but the informant is also involved in setting up a “sting” operation, initiating contact with the criminal for arrest purposes. A participant informant is just what the name suggests, a participant in the investigation of criminal activity.

—Covert informants. A covert informant also supplies information on criminal behavior to an investigator or to authorities. The difference between covert informants and other types of informants is that a covert informant is one who has been embedded in a situation or scenario for a period, sometimes for years, and is called upon only sporadically for newly uncovered information (i.e., tip-offs) and leads. These types of informants are often referred to as moles because of the nature of their insulated situation as inside sources. There are two instances in which covert informants are commonly used: in organized crime and in hate-extremist group investigations. Covert informants are often culled to get information about upcoming criminal activities by such groups.

—Accomplice/witness informants. The accomplice/witness informant is often called upon to provide information concerning criminal activity. Unlike other types of informants, the accomplice/witness informant seeks to avoid prosecution for an offense by providing investigators with helpful information. For example, the government might promise leniency if the accomplice/witness informant offers details about a co-conspirator.

There are three essential procedures for the investigator to keep in mind and follow when using sources and informants. First, strive to keep the informant’s identity as confidential as possible. Second, independently verify the information provided by the source or informant. Third, develop witness and documentary evidence from independently verified information. For example, an informant might indicate that an investigative target committed fraud. If the fraud examiner subsequently conducts an interview and gets a confession out of the target, the information is no longer dependent on the informant’s claim.

If the confidential source or informant has provided documents, names of potential witnesses, or other evidence, all reasonable steps must be taken to protect the identity of that source. Care should be taken to ensure that the questioning of other witnesses is done in a manner that does not reveal its origin. This can usually be accomplished by phrasing questions in a certain way. For example, Smith furnished confidential information about Jones, the co-owner of Jones Brothers Construction Company. When the fraud examiner confronts Jones, she does not want him to know that she has talked to Smith.

If necessary, in this example, the fraud examiner would display the evidence from witnesses and documents that would not reveal the source or informant’s identity. The information from the source or informant is basically useless unless the fraud examiner can verify its authenticity and independently corroborate it. Suppose a source furnishes the fraud examiner with copies of documents showing that Jones Brothers Construction Company’s building code violations dropped by 80 percent since a bribery arrangement allegedly began. This kind of evidence would corroborate the source’s story. If a source told the fraud examiner that Jones frequently had drinks with Walters, the city’s chief building inspector, the fraud examiner would want to find out some way to verify this information. Recall that the third objective when using sources is to develop the witness’s information and other evidence so that it makes a cohesive case.

Fraud examiners should make every effort to develop and cultivate a wide range of sources. Business and financial institution executives, law enforcement and other governmental personnel, medical and educational professionals, and internal and external auditors are always good contacts for practicing fraud examiners.

The fraud examiner should strive to make contacts in her community, well in advance of needing the information they can provide; my contacts on LinkedIn and in the Central Virginia ACFE Chapter have proven their investigative value again and again!  If the fraud examiner receives an allegation and needs confidential information, s/he might obtain assistance from a source cultivated earlier.  Additionally, we need sources to feel confident that they can share information with us without being compromised. In theory, the source will never have to testify; s/he has no firsthand knowledge. Firsthand information comes either from a witness or from a document.

The fraud examiner might also encounter new sources when tracking leads during a specific investigation. S/he might interview a stockbroker from whom the target purchased stock but who does not want his identity revealed. The fraud examiner shou1d not encourage a person to provide confidential information, but rather try to get verifying reports on the record. But if the fraud examiner promises confidentiality for a source’s information, she must abide by that promise.

The ACFE advises that active recruitment of informants is generally not desirable because doing so might appear unseemly to a jury. It is better to encourage an informant to come forward. It is also desirable to develop an informant relationship, but such relationships must be handled carefully. The fraud examiner must be careful to clearly document the adequate predication for an informant’s involvement. Generally, the most fundamental questions concerning informants will focus on the degree of their culpability or the lack of it. There have been cases where the informant is guiltier than the target; in such cases the court might rule that the informant’s information cannot be introduced.

Finally, it’s recommended that all contact with informants and-sources be reported on a memorandum, although the confidential source or informant’s identity should not be included in the report. Instead of including the source or informant’s identity, the fraud examiner should use symbols to denote the source’s identity. It is further recommended that sources be preceded with an “S,” followed by a unique identifier (i.e., source #1 would be “S-l”; source #2 would be “S-2”). The symbols for informants would then be “I-1” and “I-2.”

Generally, disclosure of the identities of sources and informants should be on a strict need to-know basis. For that reason, the person’s identity should be maintained in a secure file with limited access, and it should be cross-indexed by the source’s symbol number. The reliability of the source, if known, and whether the person can furnish relevant information should always be documented in writing.

The Threat Within

Our Chapter’s May 16th and 17th upcoming training seminar on CYBER FRAUD AND DATA BREACHES emphasizes that corporate insiders represent one of the largest threats to an organization’s vital information resources. Insiders are individuals with access or inside knowledge about an organization, and such access or knowledge gives them the ability to exploit that organization’s vulnerabilities.  Insiders enjoy two critical openings in the security structure that put them in a position to exploit organizations’ information security vulnerabilities:

• the trust of their employers
• their access to facilities

Information theft by insiders is of special concern when employees leave an organization. Often, employees leave one organization for another, taking with them the knowledge of how their former organization operates, as well as its pricing policies, manufacturing methods, customers, and so on.

The ACFE tells us that insiders can be classified into three categories:

• Employees:  employee insiders are employees with rights and access associated with being employed by the organization.
• Associates: insider associates are people with physical access to an organization’s facilities, but they are not employees of the organization (e.g., contractors, cleaning crews).
• Affiliates: insider affiliates are individuals connected to pure insiders or insider associates (e.g., spouse, friend, client), and they can use the credentials of those insiders with whom they are connected to gain access to an organization’s systems or facilities.

There are many types of potential insider threats, and they can be organized into the following categories:

• Traitors
• Zealots
• Spies
• Browsers
• Well-intentioned insiders

A traitor is a legitimate insider who misuses his or her insider credentials to facilitate malicious acts.  When a trusted insider misuses his or her privileges to violate a security policy, s/he becomes a traitor. Below are some signs that an insider may be a traitor:

• Unusual change in work habits;
• Seeking out sensitive projects;
• Unusual work hours;
• Inconsistent security habits;
• Mocking security policies and procedures;
• Rationalizing inappropriate actions;
• Changes in lifestyle;
• Living beyond his or her means.

Zealots are trusted insiders with strong and uncompromising beliefs that clash with their organization’s perspectives on certain issues and subjects. Zealots pose a threat because they might exploit their access or inside knowledge to “reform” their organizations.
Zealots might attempt reform by:

• Exposing perceived shortcomings of the organization by making unauthorized disclosures of information to the public or by granting access to outsiders;
• Destroying information;
• Halting services or the production of products.

Zealots believe that their actions are just, no matter how much damage they cause.

A spy is an individual who is intentionally placed in a situation or organization to gather intelligence. A well-placed corporate spy can provide intelligence on a target organization’s product development, product launches, and organizational developments or changes.

Spies are common in foreign, business, and competitive intelligence efforts.

Browsers are insiders who are overly curious about information to or of which they do not need access, knowledge or possession to carry out their work duties. Their curiosity drives them to review data not intended for them.  Browsers might “browse” through information that they have no specific need to know until they find something interesting or something they can use. Browsers might use such information for personal gain, or they might use it for:

• Obtaining awards;
• Supporting decisions about promotions;
• Understanding contract negotiations;
• Gaining a personal advantage over their peers.

Browsers can be the hardest insider threat to identify, and they can be even harder to defeat.

The well-intentioned insider is an insider who, through ignorance or laziness, unintentionally fosters security breaches. Well-intentioned insiders might foster security breaches by:

• Disabling anti-virus software;
• Installing unapproved software;
• Leaving their workstations or facilities unlocked;
• Using easy-to-crack passwords;
• Failing to shred or destroy sensitive information.
While well-intentioned individuals might be stellar employees when it comes to work production, their ignorance or laziness regarding information security practices can be disastrous.

CFE’s need to understand that there are numerous motivations for insider attacks including:
• Work-related grievances;
• Financial gain;
• Challenge;
• Curiosity;
• Spying for competitors;
• Revenge;
• Ego;
• Opportunity;
• Ideology (e.g., “I don’t like the way my organization conducts business.”)

There are many ways our client organizations can combat insider threats. The most effective mitigation strategies recommended by the ACFE are:

• Create an insider threat program. To combat insider threats, management should form an insider threat team, create related policies, develop processes and implement controls, and regularly communicate those policies and controls across the organization.
• Work together across the organization. To be successful, efforts to combat insider threats should be communicated across the silos of management, IT, data owners, software engineers, general counsel, and human resources.
• Address employee privacy issues with general counsel. Because employees have certain privacy rights that can affect numerous aspects of the employer-employee relationship, and because such rights may stem from, and be protected by, various elements of the law, management should consult legal counsel whenever addressing actions impacting employee privacy.
• Pay close attention at times of resignation/ termination. Because leaving an organization is a key time of concern for insider threats, management should be cautious of underperforming employees, employees at risk of being terminated, and of employees who will likely resign.
• Educate managers regarding potential recruitment. Management should train subordinates to exercise due diligence in hiring prospective employees.
• Recognize concerning behaviors as a potential indicator. Management must train managers and all employees to recognize certain behaviors or characteristics that might indicate employees are committing or are at risk of committing a breach. Common behavioral red flags are living beyond one’s financial means, experiencing financial difficulties, having an uncommonly close relationship with vendors or customers, and demonstrating excessive control over their job responsibilities.
• Mitigate threats from trusted business partners. Management should subject their organization’s contractors and outsourced organizations to the same security controls, policies, and procedures to which they subject their own employees.
• Use current technologies differently. Most organizations have implemented technologies to detect network intrusions and other threats originating outside the network perimeter, and organizations with such technologies should use them to the extent possible to detect potential indicators of malicious insider behavior within the network.
• Focus on protecting the most valuable assets. Management should dedicate the most effort to securing its most valuable organizational assets and intellectual property against insider threats.
• Learn from past incidents. Past incidents of insider threats and abuse will suggest areas of vulnerability that insiders will likely exploit again.
Additionally:
• Focus on deterrence, not detection. In other words, create a culture that deters any aberrant behavior so that those who continue to practice that behavior stand out from the “noise” of normal business; focus limited investigative resources on those individuals.
• Know your people—know who your weak links are and who would be most likely to be a threat. Use human resources data to narrow down threats rather than looking for a single needle in a pile of needles.
• Identify information that is most likely to be valuable to someone else and protect it to a greater degree than the rest of your information.
• Monitor ingress and egress points for information (e.g., USB ports, printers, network boundaries).
• Baseline normal activity and look for anomalies.
Other measures organizations might consider taking to combat insider threats include:
• Educate employees as to what information is proprietary and confidential.
• Require that all employees and third-party vendors and contractors sign nondisclosure agreements; written agreements providing that all proprietary and confidential information learned during their relationship must be kept confidential and must not be disclosed to anyone, upon the commencement and termination of employment or contracts.
• Ensure that all an organization’s third-party vendors and contractors perform background checks on all third-party employees who will have access to the organization’s information systems.
• Prohibit employees, contractors, and trusted business partners from printing sensitive documents that are not required for business purposes.
• If possible, avoid connecting information systems to those of business partners.

Also, when possible, management should conduct exit interviews with departing employees. During an exit interview, the departing employee should be advised about the organization’s trade secrets and confidential information, as well as any obligation not to disclose or use such information for his or her own benefit or for the benefit of others without express written consent. Also, the employee should be given a form to sign stating that s/he was informed that any proprietary information should not be disclosed and that s/he agrees not to disclose any such information without consent.

Finally, when management terminates its relationship with an insider, it should immediately deactivate the insider’s access to company tools and resources.

Please consider joining us for at our May 16th and 17th Spring training event, Cyber Fraud and Data Breaches for 16 CPE credits!  You may register and pay on-line here!