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| Section | Objectives |
|---|---|
| Topic 1: Financial Crimes | - Banking and Payment Fraud
|
| Topic 2: Fraud Schemes | - Financial Statement Fraud
|
| Topic 3: Fraud Investigation and Analysis | - Data analysis in fraud detection
|
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NEW QUESTION # 186
Mario performs surgery on a patient to replace a bone. The surgery should be billed using one code, but Mario bills the surgery using three codes (one for the entire surgery, one for the removal of the bone, and another for the insertion of the artificial bone), which increases the cost. Which of the following BEST describes Mario's scheme?
Answer: D
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: This is unbundling , where services that should be billed under a single comprehensive code are split into multiple components to inflate reimbursement.
* Analysis of Incorrect Options:
* A. Fictitious services - Charging for services not performed.
* B. False diagnosis - Fabricating diagnoses to justify billing.
* C. Upcoding - Billing for more expensive services than provided.
* Key Concept: Health care billing fraud - unbundling .
Reference: ACFE Fraud Examiners Manual (2020) , Fraudulent Disbursements: Health Care Billing Schemes .
NEW QUESTION # 187
Which of the following scenarios BEST illustrates a misrepresentation health care fraud scheme?
Answer: A
Explanation:
The correct answer is B. Misrepresentation in health care or insurance fraud occurs when an applicant or insured person provides false information to obtain coverage, reduce premiums, or receive benefits that would not otherwise be available. Marco falsely states that he is a nonsmoker to obtain full insurance coverage, making the application materially misleading. Option A is a fictitious claim because the procedure was canceled. Option C involves improper use of another person's policy or coverage. Option D is closer to multiple-claim or duplicate reimbursement fraud. The ACFE health care fraud materials specifically identify misrepresentation on applications as an insured or beneficiary fraud scheme, making Marco's false smoking status the best example.
NEW QUESTION # 188
Which of the following is the criterion for bid solicitation?
Answer: A
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: Fraudulent bid solicitation practices include issuing requests for proposals or bid documents that contain false statements or misleading conditions to favor a particular vendor.
* Analysis of Incorrect Options:
* B. Employment discussions - A conflict of interest, not bid solicitation fraud.
* C. Withdraw low bids - A submission phase scheme.
* D. Falsify bid log - A separate manipulation method, not solicitation criterion.
* Key Concept: Fraudulent bid solicitation - using false or misleading statements to limit competition.
Reference: ACFE Fraud Examiners Manual (2020 International Edition) , Corruption - Bid Solicitation Manipulation .
NEW QUESTION # 189
____________ is a summary of the account balances carried in a ledger.
Answer: A
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: The balance sheet summarizes account balances from the ledger at a specific date, presenting assets, liabilities, and equity. It reflects the organization's financial position and is derived from ledger balances.
* Analysis of Incorrect Options:
* B. Income statement - Summarizes revenues and expenses, not all ledger balances.
* C. Financial statement - A general term, but the specific answer here is balance sheet.
* D. General journal - Book of original entry, not a summary.
* Key Concept: Balance sheet as a summary of ledger accounts.
Reference: ACFE Fraud Examiners Manual (2020 International Edition) , Accounting Concepts - Financial Statements Overview .
NEW QUESTION # 190
A method for gaining unauthorized access to a computer system whereby the attacker deceives victims into disclosing personal information or convinces them to commit acts that facilitate the attacker's intended scheme is known as:
Answer: D
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: Social engineering involves manipulating or deceiving people into revealing confidential information or taking actions that aid the attacker (e.g., clicking malicious links, sharing credentials). It targets human weaknesses rather than technical vulnerabilities.
* Analysis of Incorrect Options:
* A. IP spoofing - Forging an IP address to disguise origin.
* B. Electronic piggybacking - Unauthorized use of someone else's access connection.
* C. Packet sniffing - Monitoring data traffic across a network.
* Key Concept: Cyberfraud techniques - social engineering.
Reference: ACFE Manual, Fraud Prevention and Deterrence - Social Engineering Attacks .
NEW QUESTION # 191
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