Best Practices

Best Practices for Fraud Investigations

Following these proven protocols preserves integrity and leads to successful enforcement:

1. Maintain Confidentiality

• Restrict case access and information sharing to only personnel directly involved
• Set expectations of discretion with external specialists assisting

2. Assemble Skilled Cross-Functional Team

• Engage financial, legal, and IT forensics experts matching case needs
• Ensure team members have fraud examination training and can maintain objectivity

3. Establish Scope, Timeline, and Investigation Plan

• Clearly define allegations or concerns prompting an investigation
• Gather basic information to determine scope parameters
• Develop a project plan outlining information gathering methods, required records, interviews, estimated duration milestones

4. Collect Information from All Available Sources

• Speak with complainants, witnesses, and accused parties
• Obtain physical and digital records – financial statements, policies, system activity logs
• Perform surveillance if necessary and permissible

5. Avoid Bias When Analyzing Findings

• Weigh all evidence objectively before reaching conclusions
• Vet analysis outcomes and assumptions with independent experts
• Document evidence solidity and gaps for transparent assessment

6. Uphold Chain of Custody for All Evidence

• Carefully log storage locations, review access and transfers
• Maintain meticulous documentation authenticating evidence validity

7. Document Methodology and Findings Meticulously

• Provide clear visibility into protocols followed based on fraud scenario
• Outline information sources, investigative procedures, and frequency
• Quantify losses and impact where fraud is affirmed

8. Issuing Recommendations

• Identify control gaps or policy lapses enabling fraud
• Highlight process and system vulnerabilities and data transparency needs
• Maintain report integrity for legal proceedings against perpetrators

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Common Types of Fraud Investigation

Corporate Fraud
Investigation

This includes financial statement manipulation, expense report fraud, and theft of IP and physical assets by employees. Warning signs include anomalies in statements, lavish staff lifestyles, and missing inventory.

Insurance Fraud
Investigation

This includes staged accidents, inflated or false injury claims, and manipulated billing by healthcare providers. Identified through data patterns, financial inconsistencies, and timed complaints.

 Cyber Fraud
Investigation

Phishing schemes result in data theft, email compromise scams targeting payments fraud, ransomware extortion cyber attacks. Warning signs include recipient account chasing and suspicious wire transfer spikes.

Bank Fraud
Investigation

Identity theft rings obtaining loans/credit cards fraudulently, unauthorized fund transfers and withdrawals, and cash skimming by employees – all requiring a meticulous credit card fraud investigation process.