Last Attempt CFE- Fraud-Schemes-and-Financial-Crimes Questions

Detailed Explanation:

Rationale for Correct Answer: The statement is false . Cressey’s fraud triangle and Albrecht’s fraud scale both emphasize that fraud is more likely when pressures are high, opportunities are present, and integrity is low . Conversely, when pressure and opportunity are low and integrity is high, the likelihood of fraud is greatly reduced.

Analysis of Incorrect Options:

A. True – Incorrect, it directly contradicts the fraud triangle and fraud scale models.

B. False – Correct, because under the conditions stated, fraud occurrence is less likely.

Key Concept: Fraud Scale Variables — Pressure, Opportunity, Integrity.

The correct answer is A. Holograms are specifically designed as anti-counterfeiting features and are among the most difficult physical card features for fraudsters to reproduce accurately. Counterfeit payment card schemes usually involve stolen account information being encoded or printed onto altered, blank, or counterfeit cards. Option B is incorrect because these schemes generally involve fraudsters, organized groups, or dishonest merchants, not collusion between card issuers and merchants. Option C is too absolute because modern technology allows counterfeit cards to be produced without traditional professional printing facilities. Option D is inaccurate because counterfeit cards usually rely on stolen or compromised active account data, not merely expired card numbers. The ACFE payment fraud materials emphasize card security features, counterfeit card production, and card-scrutiny controls.

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Detailed Explanation:

Rationale for Correct Answer: This scheme is known as a Turnaround Sale or Flip . The employee secretly purchases an asset their employer needs and then resells it to the employer at a markup, thereby profiting at the employer’s expense.

Analysis of Incorrect Options:

A. Conflict of interest in sale – Too general; does not describe the flipping mechanism.

C. Unauthorized sale – Not an ACFE fraud category in this context.

D. Written sale of unique assets – Not a recognized scheme.

Key Concept: Conflict of Interest scheme — Turnaround Sales/Flips .

Detailed Explanation:

Rationale for Correct Answer: A high percentage of coding outliers (e.g., using higher-paying diagnosis or procedure codes more often than peers) is a red flag of upcoding or fraudulent billing. This signals possible abuse of reimbursement systems.

Analysis of Incorrect Options:

A – Fewer claims would not suggest fraud.

C – Matching documentation is expected, not suspicious.

D – Low profits may indicate inefficiency, not fraud.

Key Concept: Health care fraud detection through data analytics and coding anomalies.