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| Section | Objectives |
|---|---|
| Fraud Schemes | - Fraudulent Disbursements
|
| Financial Crimes | - Financial Statement Fraud
|
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NEW QUESTION # 211
To detect fraud committed by a health care provider, a fraud examiner should look for which of the following red flags?
Answer: B
Explanation:
The correct answer is A because an unusually high number of reimbursement claims can indicate provider fraud, overutilization, fictitious services, inflated billings, or other abusive billing activity. Health care fraud detection often relies on identifying abnormal patterns compared with similar providers, patient populations, or expected service levels. A consistently low percentage of coding outliers is not, by itself, suspicious.
Producing adequate supporting documentation is generally a positive sign, although the documents should still be tested for authenticity. Creating medical records during or soon after the patient visit is proper practice because records should be timely and accurate. The ACFE health care fraud material identifies provider fraud and red flags of provider fraud as important detection areas, especially where billing volume or claim patterns appear abnormal.
NEW QUESTION # 212
Entering a sales total lower than the amount actually paid by the customer is called:
Answer: D
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: An underring occurs when an employee intentionally enters a lower sales amount into the register than what was collected from the customer. The difference is pocketed by the employee. This is a common register manipulation skimming scheme.
* Analysis of Incorrect Options:
* B. Recording a sale procedure - General process, not fraud.
* C. Internal sales audits - Control activity, not the fraud scheme.
* D. All of the above - Incorrect, since only "underring" is accurate.
* Key Concept: Underring schemes in cash register fraud.
Reference: ACFE Fraud Examiners Manual (2020 International Edition) , Cash Receipts - Skimming via Underrings .
NEW QUESTION # 213
Maria is Annie's beneficiary under a life insurance policy. The two need a large sum of money, so Maria submits a claim with a phony death certificate indicating that Annie is no longer living, even though Annie is alive and has fled to a different town. Maria and Annie's actions are an example of which of the following fraud schemes?
Answer: C
Explanation:
Maria and Annie's actions are a fraudulent death claim scheme. In life insurance fraud, a fraudulent death claim occurs when a person falsely represents that the insured has died to obtain policy proceeds. The scheme can involve a fabricated death, a phony death certificate, staged disappearance, or collusion between the insured and beneficiary. Here, Annie is alive, and Maria submits a false claim supported by a phony death certificate. A tombstone policy claim generally involves policies or claims connected to deceased persons or fraudulent use of death information, but the facts here involve a living insured falsely reported as dead.
Premium theft concerns misappropriation of premiums, and beneficiary extortion is not the scheme described.
NEW QUESTION # 214
Which of the following is NOT a justifiable reason to depart from generally accepted accounting principles (GAAP)?
Answer: A
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: Departures from GAAP may be justified if compliance produces misleading results, if the transaction is immaterial, or if the costs exceed benefits. However, simply departing from GAAP because assets would be understated and liabilities overstated is not an acceptable reason ; GAAP requires faithful representation even if results are unfavorable.
* Analysis of Incorrect Options:
* A - Cost-benefit considerations are valid grounds in practice.
* C - Materiality is a recognized exception to strict GAAP application.
* D - Preventing misleading statements is a valid justification.
* Key Concept: GAAP exceptions are limited to cost-benefit, immateriality, and preventing misleading reporting .
Reference: ACFE Manual, Accounting Concepts - GAAP Principles .
NEW QUESTION # 215
Which of the following are used in a short-term skimming scheme?
Answer: B
Explanation:
Detailed Explanation:
* Rationale for Correct Answer: Short-term skimming schemes include tactics like unrecorded sales
, understated sales , and theft of incoming checks . These involve diverting funds before recording and typically last for a shorter duration because of higher detection risk.
* Analysis of Incorrect Options:
* B. Dual endorsements - Relates more to check fraud, not skimming.
* C. False company accounts - Typically used in long-term fraud concealment.
* D. Check-for-currency substitutions - More relevant to larceny and kiting schemes.
* Key Concept: Short-term skimming schemes involve quick thefts before recording transactions.
Reference: ACFE Fraud Examiners Manual (2020 International Edition) , Cash Receipts - Short-term Skimming .
NEW QUESTION # 216
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