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Fraud Detection Using a
        Database Platform


                         Mike Blakley
Central
Carolina
Chapter of the
Association of
Certified Fraud                               February 23, 2009
Examiners
  Fraud Detetcion using a database platform                EZ-R Stats, LLC
Session objectives

             Understand why and how
      1.
             Understand statistical basis for
      2.
             quantifying differences
             Identify ten general tools and
      3.
             techniques
             Understand how pattern
      4.
             detection fits in
Fraud detection using a database platform   EZ-R Stats, LLC
Session agenda and timings

     Managing the business risk of fraud (30 minutes)


     Overview of statistical approach (10 min)


     Discussion of databases (10 min)


     Break (10 min)


     Details of the approach (40 min)


     Brief demo (5 min)


     Open discussion and question and answer (15 min)





    Fraud detection using a database platform   EZ-R Stats, LLC
Handout (CD)

     CD with articles and software


     PowerPoint presentation


     More info at www.ezrstats.com





    Fraud detection using a database platform   EZ-R Stats, LLC
Optional quiz

     Test your understanding


     Entirely optional


     On home page under “events” – quiz


     Results can be e-mailed





    Fraud detection using a database platform   EZ-R Stats, LLC
“Cockroach” theory of auditing

     If you spot one roach….





    Fraud detection using a database platform   EZ-R Stats, LLC
“Cockroach” theory of auditing

     There are probably 30

     more that you don’t
     see…




    Fraud detection using a database platform   EZ-R Stats, LLC
Statistics based “roach” hunting




   Many frauds coulda/woulda/shoulda been detected with analytics

Fraud detection using a database platform          EZ-R Stats, LLC
Overview
          Fraud patterns detectable with
        
          digital analysis
         Basis for digital analysis
          approach
         Usage examples
         Continuous monitoring
         Business analytics

Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1

         The Why and How

                      Three brief examples
               

                      ACFE/IIA/AICPA Guidance Paper
               

                      Practice Advisory 2320-1
               

                      Auditors “Top 10”
               

                      Process Overview
               

                      Who, What, Why, When & Where
               




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1a
          Example 1
Wake County Transportation Fraud

                       Supplier Kickback – School Bus
                   
                       parts
                       $5 million
                   

                       Jail sentences
                   

                       Period of years
                   




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1a


Too little too late

                  Understaffed internal audit
              

                  Software not used
              

                  Data on multiple platforms
              

                  Transaction volumes large
              




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1a

                                 Preventable

               Need structured, objective
           
               approach
               Let the data “talk to you”
           

               Need efficient and effective
           
               approach




Fraud detection using a database platform      EZ-R Stats, LLC
Objective 1

             Regression Analysis

     Stepwise to find

     relationships
           Forwards
       –

           Backwards
       –

     Intervals

           Confidence
       –

           Prediction
       –




    Fraud detection using a database platform     EZ-R Stats, LLC
Objective 1

                           Data outliers

       Sometimes an “out
   
       and out Liar”
       But how do you
   
       detect it?




Fraud detection using a database platform     EZ-R Stats, LLC
Objective 1

           Data Outliers

     Plot transportation costs vs.

     number of buses
     “Drill down” on costs

           Preventive maintenance
       –

           Fuel
       –

           Inspection
       –




    Fraud detection using a database platform     EZ-R Stats, LLC
Scatter plot with prediction and
       confidence intervals




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1a
                                        Example 2
Cost of six types of AIDS drugs

                                       Total Cost of AIDS Drugs

                          200

                          150                                                     NDC1
          Dollar Amount




                                                                                  NDC2
                          100
                                                                                  NDC3
                           50                                                     NDC4
                                                                                  NDC5
                            0
                                                                                  NDC6
                                NDC1    NDC2   NDC3    NDC4   NDC5     NDC6
                                                 Drug Type




Fraud detection using a database platform                            EZ-R Stats, LLC
Objective 1

       Medicare HIV Infusion Costs
          CMS Report for 2005
      

          South Florida - $2.2 Billion
      

          Rest of the country combined -
      
          $.1 Billion




Fraud detection using a database platform     EZ-R Stats, LLC
Objective 1
                                           Pareto Chart
                                           Medicare HIV Infusion Costs - 2005 ($Billions)
                                                     data source: HHS CMS

                                       120.0%


                                       100.0%
               Annual Medicare Costs




                                       80.0%

                                                                                            Pct
                                       60.0%
                                                                                            Cum Pct

                                       40.0%

                                       20.0%


                                        0.0%
                                            1

                                                3

                                                     5

                                                          7

                                                               9

                                                                   11

                                                                        13

                                                                             15
                                                              County




Fraud detection using a database platform                                                         EZ-R Stats, LLC
Objective 1a
                                            Example 2
        Typical Prescription Patterns

                                        AIDS Drugs Prescription Patterns

                            60.0
                                                                                             NDC1
                            50.0
                                                                                             NDC2
                            40.0
             Dollar Value




                                                                                             NDC3
                            30.0
                                                                                             NDC4
                            20.0
                                                                                             NDC5
                            10.0                                                             NDC6
                             0.0
                                   Prov 1   Prov 2   Prov 3   Prov 4   Prov 5     Prov 6
                                                       Prescriber



Fraud detection using a database platform                                       EZ-R Stats, LLC
Objective 1a
                                           Example 2
                    Prescriptions by Dr. X

                                    Dr. X compared with Total Population
                              350
                              300
                              250
              Dollar Amount




                              200
                                                                                Population
                              150
                              100                                               Dr. X
                               50
                                0
                                    NDC1   NDC2   NDC3   NDC4   NDC5   NDC6
                                                   Drug Type




Fraud detection using a database platform                              EZ-R Stats, LLC
Objective 1a
                               Example 2
                             Off-label use

       Serostim
   
             Treat wasting syndrome, side effect of
         –
             AIDS, OR
             Used by body builders for recreational
         –
             purposes
             One physician prescribed $11.5 million
         –
             worth (12% of the entire state)



Fraud detection using a database platform    EZ-R Stats, LLC
Objective 1a
                                         Example 3
                                    Revenue trends

                                               Overall Revenue Trend

                                  1.2
                                 1.15
               Annual Billings




                                  1.1
                                                                               Overall
                                 1.05
                                                                               Linear (Overall)
                                   1
                                 0.95
                                  0.9
                                        2001          2002        2003
                                                  Calendar Year




Fraud detection using a database platform                                EZ-R Stats, LLC
Example 3                     Objective 1a

                                 Dental Billings

                                      Rapid Increase in Revenues

                                 5
                                 4
               Annual Billings




                                                                      Billings A
                 ($millions)




                                 3
                                                                      Billings B
                                 2
                                                                      Linear (Billings A)
                                 1
                                 0
                                     2001       2002        2003
                                            Calendar Year




Fraud detection using a database platform                          EZ-R Stats, LLC
Objective 1b

               Guidance Paper

         A proposed implementation approach
     
         “Managing the Business Risk of Fraud: A
     
         Practical Guide” http://tinyurl.com/3ldfza
         Five Principles
     
         Fraud Detection
     
         Coordinated Investigation Approach
     




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1b

Managing the Business Risk of
Fraud: A Practical Guide

                     ACFE, IIA and AICPA
                 
                     Exposure draft issued
                     11/2007, final 5/2008
                     Section 4 – Fraud
                 
                     Detection




 Fraud detection using a database platform   EZ-R Stats, LLC
Guidance Paper

         Five Sections
     
              Fraud Risk Governance
          –

              Fraud Risk Assessment
          –

              Fraud Prevention
          –

              Fraud Detection
          –

              Fraud Investigation and
          –
              corrective action




Fraud detection using a database platform   EZ-R Stats, LLC
Risk Governance

     Fraud risk management program


     Written policy – management’s expectations

     regarding managing fraud risk




    Fraud detection using a database platform   EZ-R Stats, LLC
Risk Assessment

     Periodic review and assessment of potential

     schemes and events
     Need to mitigate risk





    Fraud detection using a database platform   EZ-R Stats, LLC
Fraud Prevention

     Establish prevention techniques


     Mitigate possible impact on the organization





    Fraud detection using a database platform   EZ-R Stats, LLC
Fraud Detection

     Establish detection techniques for fraud


     “Back stop” where preventive measures fail,

     or
     Unmitigated risks are realized





    Fraud detection using a database platform   EZ-R Stats, LLC
Fraud Investigation and Corrective
Action

     Reporting process to solicit input on fraud


     Coordinated approach to investigation


     Use of corrective action





    Fraud detection using a database platform   EZ-R Stats, LLC
“60 Minutes” – “World of Trouble”

         2/15/09 – Scott Pelley
     
              Fraud Risk Governance – “one grand wink-wink,
          –
              nod-nod “
              Fraud Risk Assessment - categorically false
          –

              Fraud Prevention – “my husband passed away”
          –

              Fraud Detection - We didn't know? Never saw one.
          –

              Fraud Investigation and corrective action - Pick-A-
          –
              Payment losses $36 billion




Fraud detection using a database platform           EZ-R Stats, LLC
Objective 1b


Section 4 – Fraud Detection
              Detective Controls
          

              Process Controls
          

              Anonymous Reporting
          

              Internal Auditing
          

              Proactive Fraud Detection
          




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1b


Proactive Fraud Detection

                      Data Analysis to identify:
                 
                      – Anomalies
                      – Trends
                      – Risk indicators




 Fraud detection using a database platform    EZ-R Stats, LLC
Fraud Detective Controls

     Operate in the background


     Not evident in everyday business

     environment
     These techniques usually –

           Occur in ordinary course of business
       –

           Corroboration using external information
       –

           Automatically communicate deficiencies
       –

           Use results to enhance other controls
       –


    Fraud detection using a database platform   EZ-R Stats, LLC
Examples of detective controls

     Whistleblower hot-lines (DHHS and OSA

     have them)
     Process controls (Medicaid audits and edits)


     Proactive fraud detection procedures

           Data analysis
       –

           Continuous monitoring
       –

           Benford’s Law
       –




    Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1b


Specific Examples Cited

                  Journal entries – suspicious
             
                  transactions
                  Identification of relationships
             

                  Benford’s Law
             

                  Continuous monitoring
             




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1b
Data Analysis enhances ability to
detect fraud

                    Identify hidden relationships
               

                    Identify suspicious transactions
               

                    Assess effectiveness of internal
               
                    controls
                    Monitor fraud threats
               

                    Analyze millions of transactions
               




 Fraud detection using a database platform       EZ-R Stats, LLC
Continuous Monitoring of Fraud
Detection

     Organization should develop ongoing

     monitoring and measurements
     Establish measurement criteria (and

     communicate to Board)
     Measurable criteria include:





    Fraud detection using a database platform   EZ-R Stats, LLC
Measurable Criteria – number of

     fraud allegations


     fraud investigations resolved


     Employees attending annual ethics course


     Whistle blower allegations


     Messages supporting ethical behavior

     delivered by executives
     Vendors signing ethical behavior standards



    Fraud detection using a database platform   EZ-R Stats, LLC
Management ownership of each
technique implemented

     Each process owner should:

           Evaluate effectiveness of technique regularly
       –

           Adjust technique as required
       –

           Document adjustments
       –

           Report modifications needed for techniques which
       –
           become less effective




    Fraud detection using a database platform   EZ-R Stats, LLC
Practice Advisory 2320-1
Analysis and Evaluation

     International standards for the professional

     practice of Internal Auditing
     Analytical audit procedures

           Efficient and effective
       –

           Useful in detecting
       –
                Differences that are not expected
            

                Potential errors
            

                Potential irregularities
            




    Fraud detection using a database platform       EZ-R Stats, LLC
Analytical Audit Procedures

          May include
      
          – Study of relationships
          – Comparison of amounts with
            similar information in the
            organization
          – Comparison of amounts with
            similar information in the
            industry
Fraud detection using a database platform   EZ-R Stats, LLC
Analytical audit procedures

     Performed using monetary amounts, physical

     quantities, ratios or percentages
     Ratio, trend and regression analysis


     Period to period comparisons


     Auditors should use analytical audit

     procedures in planning the engagement



    Fraud detection using a database platform   EZ-R Stats, LLC
Factors to consider

     Significance of the area being audited


     Assessment of risk


     Adequacy of system of internal control


     Availability and reliability of information


     Extent to which procedures provide support

     for engagement results


    Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1c


           Peeling the Onion

                                            Fraud Items
                                   Possible Error Conditions
                                       Population as Whole




Fraud detection using a database platform             EZ-R Stats, LLC
Objective 1d


          Fraud Pattern Detection

                                   Round Numbers
                                               Benford’s Law
                        Market Basket



                 Stratification                          Gaps

                                      Target Group

                  Trend Line                          Univariate



                                                Duplicates
                            Holiday
                                      Day of Week


Fraud detection using a database platform                      EZ-R Stats, LLC
Objective 1e



Digital Analysis (5W)
              Who
            
             What
             Why
             Where
             When




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e


Who Uses Digital Analysis

                   Traditionally, IT specialists
               
                   With appropriate tools, audit
               
                   generalists (CAATs)
                   Growing trend of business
               
                   analytics
                   Essential component of
               
                   continuous monitoring


 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e


           What - Digital Analysis

                Using software to:
            
                     Classify
                 –

                     Quantify
                 –

                     Compare
                 –

                Both numeric and non-numeric
            
                data



Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e


    How - Assessing fraud risk

          Basis is quantification
      

          Software can do the “leg work”
      

          Statistical measures of difference
      
          – Chi square
          – Kolmogorov-Smirnov
          – D-statistic

          Specific approaches
      


Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e


        Why - Advantages

        Automated process
    
        Handle large data populations
    
        Objective, quantifiable metrics
    
        Can be part of continuous monitoring
    
        Can produce useful business analytics
    
        100% testing is possible
    
        Quantify risk
    
        Repeatable process
    



Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e


         Why - Disadvantages

             Costly (time and software costs)
         

             Learning curve
         

             Requires specialized knowledge
         




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e



      When to Use Digital Analysis

                Traditional – intermittent (one off)
            

                Trend is to use it as often as possible
            

                Continuous monitoring
            

                Scheduled processing
            




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1e



       Where Is It Applicable?

               Any organization with data in digital
           
               format, and especially if:
                    Volumes are large
                –

                    Data structures are complex
                –

                    Potential for fraud exists
                –




Fraud detection using a database platform     EZ-R Stats, LLC
Objective 1

Objective 1 Summarized

            Three brief examples
     

            CFE Guidance Paper
     

            “Top 10” Metrics
     

            Process Overview
     

            Who, What, Why, When & Where
     




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 1 - Summarized

             Understand why and how
     1.
             Understand statistical basis for quantifying
     2.
             differences
             Identify ten general tools and techniques
     3.
             Understand use of Excel
     4.
             How pattern detection fits in
     5.




               Next is the basis …
Fraud detection using a database platform     EZ-R Stats, LLC
Objective 2


Basis for Pattern Detection

    Analytical review


    Isolate the “significant few”


    Detection of errors


    Quantified approach





Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2

         Understanding the Basis

                 Quantified Approach
         

                 Population vs. Groups
         

                 Measuring the Difference
         

                 Stat 101 – Counts, Totals, Chi
         
                 Square and K-S
                 The metrics used
         




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2a


        Quantified Approach

          Based on measureable
        
          differences
         Population vs. Group
         “Shotgun” technique




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2a


Detection of Fraud Characteristics

     Something is different than expected





    Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2b



Fraud patterns

          Common theme – “something is
        
          different”
         Groups
         Group pattern is different than
          overall population


 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2c



      Measurement Basis

            Transaction
             counts
            Transaction
             amounts


Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d

        A few words about statistics
               (the “s” word)

            Detailed knowledge of statistics not
        
            necessary
            Software packages do the “number-
        
            crunching”
            Statistics used only to highlight
        
            potential errors/frauds
            Not used for quantification
        




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d

How is digital analysis done?

             Comparison of group with population as a
        
             whole
             Can be based on either counts or amounts
        
             Difference is measured
        
             Groups can then be ranked using a selected
        
             measure
             High difference = possible error/fraud
        




Fraud detection using a database platform   EZ-R Stats, LLC
Demo in Excel of the process

     Based roughly on the Wake County

     Transportation fraud
     Illustrates how the process works, using

     Excel




    Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d


                           Histograms

    Attributes tallied and categorized into “bins”


    Counts or sums of amounts





Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d


             Two histograms obtained

                                      Population and group
                               
                               Population                                                            Group

   700                                                                 80
   600                                                                 70
                                                                       60
   500
                                                                       50
   400
                                                                       40
   300
                                                                       30
   200
                                                                       20
   100                                                                 10
     0                                                                  0
         Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec-        Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec-
          07 07 07 07 07 07 07 07 07 07 07 07                                07 07 07 07 07 07 07 07 07 07 07 07




Fraud detection using a database platform                                                                    EZ-R Stats, LLC
Objective 2d


                           Histograms

      Attributes tallied and categorized into “bins”
  

      Counts or sums of amounts
  




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d


  Compute Cumulative Amount for each


                    Count by Month
                                                                  Cum Pct
               80
                                            120.0%
               70

                                            100.0%
               60

               50
                                            80.0%
       Count




               40
                                            60.0%
               30

               20                           40.0%
               10
                                            20.0%
               0
               Au 07
                Ju 7
               Fe 7




               Ju 7
               Ap 7




                     07
               M 07




               O7


               De 7
               No 07
               Se 7




                                             0.0%
               M7
                    -0
                    -0




                     0


                     0
                     0
                  n-0




                     0
                  r-0




                   l-




                  c-
                  p-


                  v-
                  n-
                  b-




                 ct-
                 g-
                ay
                 ar
               Ja




                                                                            7
                                                                  07
                                                  07




                                                                                    07


                                                                                               7
                                                          07




                                                                         l-0




                                                                                             -0
                           M onth




                                                                                  p-
                                                                   -
                                                n-


                                                           -




                                                                                          ov
                                                                ay
                                                        ar




                                                                       Ju
                                              Ja




                                                                                Se
                                                       M




                                                                                         N
                                                               M



Fraud detection using a database platform                               EZ-R Stats, LLC
Objective 2d


Are the histograms different?

                  Two statistical measures of
              
                  difference
                  Chi Squared (counts)
              
                  K-S (distribution)
              
                  Both yield a difference metric
              




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d

                           Chi Squared


                Classic test on data in a table
            

                Answers the question – are the
            
                rows/columns different
                Some limitations on when it can be
            
                applied




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d


                       Chi Squared

                    Table of Counts
                

                    Degrees of Freedom
                

                    Chi Squared Value
                

                    P-statistic
                

                    Computationally intensive
                




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d



Kolmogorov-Smirnov



                   Two Russian
                 
                   mathematicians
                  Comparison of distributions
                  Metric is the “d-statistic”


 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d


          How is K-S test done?

              Four step process
      

                  For each cluster element
            1.
                  determine percentage
                  Then calculate cumulative
            2.
                  percentage
                  Compare the differences in
            3.
                  cumulative percentages
                  Identify the largest difference
            4.
Fraud detection using a database platform   EZ-R Stats, LLC
Objective 2d - KS


              Kolmogorov-Smirnov




Fraud detection using a database platform      EZ-R Stats, LLC
Objective 2e


   Classification by metrics

               Stratification
           
               Day of week
           
               Happens on holiday
           
               Round numbers
           
               Variability
           
               Benford’s Law
           
               Trend lines
           
               Relationships (market basket)
           
               Gaps
           
               Duplicates
           




Fraud detection using a database platform      EZ-R Stats, LLC
Objective e


      Auditor’s “Top 10” Metrics

                            Outliers / Variability
                    1.
                            Stratification
                    2.
                            Day of Week
                    3.
                            Round Numbers
                    4.
                            Made Up Numbers
                    5.
                            Market basket
                    6.
                            Trends
                    7.
                            Gaps
                    8.
                            Duplicates
                    9.
                            Dates
                    10.




Fraud detection using a database platform            EZ-R Stats, LLC
Objective 2

Understanding the Basis

                   Quantified Approach
           

                   Population vs. Groups
           

                   Measuring the Difference
           

                   Stat 101 – Counts, Totals, Chi Square
           
                   and K-S
                   The metrics used
           




 Fraud detection using a database platform     EZ-R Stats, LLC
Objective 2 - Summarized

             Understand why and how
     1.
             Understand statistical basis for quantifying
     2.
             differences
             Identify ten general tools and techniques
     3.
             Understand examples done using Excel
     4.
             How pattern detection fits in
     5.




                Next are the metrics …


Fraud detection using a database platform            EZ-R Stats, LLC
It’s that time!



        Session Break!


Fraud detection using a database platform   EZ-R Stats, LLC
Objective 3

         The “Top 10” Metrics

    Overview


    Explain Each Metric


    Examples of what it can detect


    How to assess results





Fraud detection using a database platform   EZ-R Stats, LLC
Objective 3


                Trapping anomalies




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 3


          Fraud Pattern Detection
                                    Round Numbers
                                               Benford’s Law
                        Market Basket



                 Stratification                          Gaps

                                      Target Group

                   Trend Line                         Univariate



                                                Duplicates
                            Holiday
                                      Day of Week




Fraud detection using a database platform                    EZ-R Stats, LLC
1 - Outliers

           Outliers / Variability

              Outliers are
              amounts which
              are significantly
              different from the
              rest of the
              population
Fraud detection using a database platform   EZ-R Stats, LLC
1 - Outliers

                  Outliers / Variability

                  Charting (visual)
              

                  Software to analyze “z-scores”
              

                  Top and Bottom 10, 20 etc.
              

                  High and low variability (coefficient
              
                  of variation)




Fraud detection using a database platform       EZ-R Stats, LLC
1 - Outliers


      Drill down to the group level

                 Basic statistics
             
                  – Minimum, maximum
                    and average
                  – Variability

                 Sort by statistic of interest
             
                  – Variability (coefficient
                    of variation)
                  – Maximum, etc.


Fraud detection using a database platform        EZ-R Stats, LLC
1 - Outliers

                    Example Results

               Provider                     N           Coeff Var
                    3478421                     3,243        342.23
                    2356721                     4,536         87.23
                    3546789                     3,421         23.25
                    5463122                     2,311         18.54

          Two providers (3478421 and
          2356721) had significantly more
          variability in the amounts of their
          claims than all the rest.
Fraud detection using a database platform                      EZ-R Stats, LLC
Next Metric

                          Outliers
                   1.
                          Stratification
                   2.
                          Day of Week
                   3.
                          Round Numbers
                   4.
                          Made Up Numbers
                   5.
                          Market basket
                   6.
                          Trends
                   7.
                          Gaps
                   8.
                          Duplicates
                   9.
                          Dates
                   10.

Fraud detection using a database platform   EZ-R Stats, LLC
2 - Stratification

        Unusual stratification
             patterns

                                             Do you
                                            know how
                                            your data
                                             looks?
Fraud detection using a database platform       EZ-R Stats, LLC
2 - Stratification


                 Stratification - How

          Charting (visual)
        
         Chi Squared
         Kolmogorov-Smirnov
         By groups




Fraud detection using a database platform     EZ-R Stats, LLC
2 – Stratification

    Purpose / types of errors

          Transactions out of the ordinary
      

          “Up-coding” insurance claims
      

          “Skewed” groupings
      

          Based on either count or amount
      




Fraud detection using a database platform         EZ-R Stats, LLC
2 – Stratification

              The process?

             Stratify the entire population into
      1.
             “bins” specified by auditor
             Same stratification on each group
      2.
             (e.g. vendor)
             Compare the group tested to the
      3.
             population
             Obtain measure of difference for each
      4.
             group
             Sort descending on difference
      5.
             measure

Fraud detection using a database platform         EZ-R Stats, LLC
2 – Stratification
          Units of Service Stratified -
               Example Results

         Provider                 N         Chi Sq      D-stat
            2735211                 6,011      7,453     0.8453
            4562134                 8,913      5,234     0.7453
            4321089                 3,410       342      0.5231
            4237869                 2,503       298      0.4632


         Two providers (2735211 and
         4562134) are shown to be much
         different from the overall population
         (as measured by Chi Square).
Fraud detection using a database platform              EZ-R Stats, LLC
Next Metric

                             Outliers
                      1.
                             Stratification
                      2.
                             Day of Week
                      3.
                             Round Numbers
                      4.
                             Made Up Numbers
                      5.
                             Market basket
                      6.
                             Trends
                      7.
                             Gaps
                      8.
                             Duplicates
                      9.
                             Dates
                      10.


Fraud detection using a database platform      EZ-R Stats, LLC
3 – Day of Week

                         Day of Week

                    Activity on weekdays
                

                    Activity on weekends
                

                    Peak activity mid to late week
                




Fraud detection using a database platform     EZ-R Stats, LLC
3 – Day of Week

Purpose / Type of Errors

                Identify unusually high/low
            
                activity on one or more days of
                week
                Dentist who only handled
            
                Medicaid on Tuesday
                Office is empty on Friday
            




 Fraud detection using a database platform        EZ-R Stats, LLC
How it is done?

            Programmatically check entire population
        
            Obtain counts and sums by day of week
        
            (1-7)
            Prepare histogram
        
            For each group do the same procedure
        
            Compare the two histograms
        
            Sort descending by metric (chi square/d-
        
            stat)


Fraud detection using a database platform   EZ-R Stats, LLC
3 – Day of Week

          Day of Week - Example Results


          Provider                N           Chi Sq         D-stat
              2735211                 5,404      12,435        0.9802
              4562134                 5,182       7,746        0.8472
              4321089                 5,162            87       0.321
              4237869                 7,905            56      0.2189

      Provider 2735211 only provided
      service for Medicaid on Tuesdays.
      Provider 4562134 was closed on
      Thursdays and Fridays.
Fraud detection using a database platform                   EZ-R Stats, LLC
Next Metric

                         Outliers
                  1.
                         Stratification
                  2.
                         Day of Week
                  3.
                         Round Numbers
                  4.
                         Made Up Numbers
                  5.
                         Market basket
                  6.
                         Trends
                  7.
                         Gaps
                  8.
                         Duplicates
                  9.
                         Dates
                  10.


Fraud detection using a database platform   EZ-R Stats, LLC
4 – Round Numbers


                Round Numbers


                                            It’s about….
                                              Estimates!



Fraud detection using a database platform           EZ-R Stats, LLC
4 – Round Numbers

           Purpose / Type of Errors

     Isolate estimates


     Highlight account numbers in

     journal entries with round
     numbers
     Split purchases (“under the radar”)


     Which groups have the most

     estimates



    Fraud detection using a database platform         EZ-R Stats, LLC
4 – Round Numbers

                  Round numbers

            Classify population amounts
       
             – $1,375.23 is not round
             – $5,000 is a round number – type 3 (3
               zeros)
             – $10,200 is a round number type 2 (2
               zeros)
            Quantify expected vs. actual (d-statistic)
       
            Generally represents an estimate
       
            Journal entries
       




Fraud detection using a database platform         EZ-R Stats, LLC
4 – Round Numbers
   Round Numbers in Journal
   Entries - Example Results

         Account                 N           Chi Sq     D-stat
            2735211                  4,136     54,637     0.9802
            4562134                   833      35,324   0.97023
            4321089                  8,318        768      0.321
            4237869                  9,549        546     0.2189

        Two accounts, 2735211 and 4562134
        have significantly more round number
        postings than any other posting
        account in the journal entries.
Fraud detection using a database platform               EZ-R Stats, LLC
Next Metric

                          Outliers
                  1.
                          Stratification
                  2.
                          Day of Week
                  3.
                          Round Numbers
                  4.
                          Made Up Numbers
                  5.
                          Market basket
                  6.
                          Trends
                  7.
                          Gaps
                  8.
                          Duplicates
                  9.
                          Dates
                  10.

Fraud detection using a database platform   EZ-R Stats, LLC
5 – Made up numbers


               Made up Numbers

                Curb stoning
                Imaginary numbers
                Benford’s Law

Fraud detection using a database platform         EZ-R Stats, LLC
5 – Made Up Numbers


               What can be detected
     Made up numbers –

     e.g. falsified inventory
     counts, tax return
     schedules




    Fraud detection using a database platform            EZ-R Stats, LLC
5 – Made Up Numbers


       Benford’s Law using Excel

              Basic formula is “=log(1+(1/N))”
          

              Workbook with formulae available at
          
              http://tinyurl.com/4vmcfs
              Obtain leading digits using “Left”
          
              function, e.g. left(Cell,1)




Fraud detection using a database platform            EZ-R Stats, LLC
5 – Made Up Numbers


                   Made up numbers

                Benford’s Law
           

                Check Chi Square and d-statistic
           

                First 1,2,3 digits
           

                Last 1,2 digits
           

                Second digit
           

                Sources for more info
           




Fraud detection using a database platform            EZ-R Stats, LLC
5 – Made Up Numbers
            How is it done?

            Decide type of test – (first 1-3 digits, last
        
            1-2 digit etc)
            For each group, count number of
        
            observations for each digit pattern
            Prepare histogram
        
            Based on total count, compute expected
        
            values
            For the group, compute Chi Square and
        
            d-stat
            Sort descending by metric (chi square/d-
        
            stat)
Fraud detection using a database platform            EZ-R Stats, LLC
5 – Made Up Numbers
            Invoice Amounts tested with
           Benford’s law - Example Results
         Store              Hi Digit        Chi Sq      D-stat
                 324                   79       5,234      0.9802
                 563                   89       4,735     0.97023
                 432                   23        476         0.321
                 217                   74        312       0.2189


            During tests of invoices by store, two
            stores, 324 and 563 have significantly
            more differences than any other store
            as measured by Benford’s Law.


Fraud detection using a database platform               EZ-R Stats, LLC
Next Metric

                           Outliers
                   1.
                           Stratification
                   2.
                           Day of Week
                   3.
                           Round Numbers
                   4.
                           Made Up Numbers
                   5.
                           Market basket
                   6.
                           Trends
                   7.
                           Gaps
                   8.
                           Duplicates
                   9.
                           Dates
                   10.


Fraud detection using a database platform    EZ-R Stats, LLC
6 – Market Basket

                       Market Basket


          Medical “Ping ponging”
      
          Pattern associations
      
          Apriori program
      
          References at end of slides
      
          Apriori – Latin a (from) priori
      
          (former)
          Deduction from the known
      


Fraud detection using a database platform        EZ-R Stats, LLC
6 – Market basket

               Purpose / Type of Errors

          Unexpected patterns and
      
          associations
          Based on “market basket” concept
      

          Unusual combinations of diagnosis
      
          code on medical insurance claim




Fraud detection using a database platform         EZ-R Stats, LLC
6 – Market basket

                     Market Basket

                 JE Accounts
               
                JE Approvals
                Credit card fraud in Japan –
                 taxi and ATM




Fraud detection using a database platform         EZ-R Stats, LLC
6 – Market basket

                       How is it done?

                   First, identify groups, e.g. all
              
                   medical providers for a patient
                   Next, for each provider, assign a
              
                   unique integer value
                   Create a text file containing the
              
                   values
                   Run “apriori” analysis
              




Fraud detection using a database platform         EZ-R Stats, LLC
6 – Market basket

        Apriori outputs

                For each unique value, probability of
            
                other values
                If you see Dr. Jones, you will also
            
                see Dr. Smith (80% probability)
                If you see a JE to account ABC, there
            
                will also an entry to account XYZ
                (30%)



Fraud detection using a database platform         EZ-R Stats, LLC
Next Metric
                      Outliers
               1.
                      Stratification
               2.
                      Day of Week
               3.
                      Round Numbers
               4.
                      Made Up Numbers
               5.
                      Market basket
               6.
                      Trends
               7.
                      Gaps
               8.
                      Duplicates
               9.
                      Dates
               10.


Fraud detection using a database platform   EZ-R Stats, LLC
7 - Trends

                         Trend Busters
              Does the pattern make sense?

                                                       ACME Technology

                        30,000
                        25,000
                        20,000
               Amount




                                                                              Sales
                        15,000
                                                                              Em ployee Count
                        10,000
                         5,000
                             0
                                             7




                                                                 8
                                    7




                                                         M8
                                                  7


                                                               07
                              7




                                                               08
                                                                7
                                           -0




                                                              -0
                                  -0




                                                              -0
                                                 l-0
                              0




                                                          0
                                                            v-
                           n-




                                                            n-
                                                       p-
                                       ay




                                                          ay
                                  ar




                                                           ar
                                             Ju



                                                         No
                         Ja




                                                         Ja
                                                   Se
                                 M




                                                         M
                                       M




                                                          Date




Fraud detection using a database platform                                EZ-R Stats, LLC
7 – Trends

                   Trend Busters

              Linear regression
          

              Sales are up, but cost of goods sold is
          
              down
              “Spikes”
          




Fraud detection using a database platform     EZ-R Stats, LLC
7 – Trends

      Purpose / Type of Errors

                 Identify trend lines, slopes,
             
                 etc.
                 Correlate trends
             
                 Identify anomalies
             
                 Key punch errors where
             
                 amount is order of
                 magnitude

Fraud detection using a database platform     EZ-R Stats, LLC
7 – Trends

       Linear Regression
      Test relationships (e.g.
       invoice amount and sales
       tax)
      Perform multi-variable
       analysis

Fraud detection using a database platform     EZ-R Stats, LLC
7 – Trends

                       How is it done?

           Estimate linear trends using “best
       
           fit”
           Measure variability (standard
       
           errors)
           Measure slope
       

           Sort descending by slope,
       
           variability, etc.

Fraud detection using a database platform     EZ-R Stats, LLC
7 – Trends
           Trend Lines by Account - Example
                        Results


          Account               N           Slope         Std Err
                 32451                 18       1.230               0.87
                 43517                 17       1.070                4.3
                 32451                 27       1.023               0.85
                 43517                 32       1.010               0.36
                 43870                 23       0.340               2.36
                 54630                 56       -0.560              1.89


       Generally the trend is gently sloping
       up, but two accounts (43870 and
       54630) are different.
Fraud detection using a database platform                 EZ-R Stats, LLC
Scatter plot with prediction and
      confidence intervals




Fraud detection using a database platform   EZ-R Stats, LLC
Next Metric
                           Outliers
                    1.
                           Stratification
                    2.
                           Day of Week
                    3.
                           Round Numbers
                    4.
                           Made Up Numbers
                    5.
                           Market basket
                    6.
                           Trends
                    7.
                           Gaps
                    8.
                           Duplicates
                    9.
                           Dates
                    10.


Fraud detection using a database platform    EZ-R Stats, LLC
8 - Gaps

Numeric Sequence Gaps


     What’s there is
     interesting, what’s not
     there is critical …

Fraud detection using a database platform   EZ-R Stats, LLC
8 – Gaps

    Purpose / Type of Errors

        Missing documents (sales, cash,
    
        etc.)
        Inventory losses (missing receiving
    
        reports)
        Items that “walked off”
    




Fraud detection using a database platform    EZ-R Stats, LLC
8 – Gaps

                       How is it done?

              Check any sequence of numbers
          
              supposed to be complete, e.g.
              Cash receipts
          

              Sales slips
          

              Purchase orders
          




Fraud detection using a database platform    EZ-R Stats, LLC
8 – Gaps

            Gaps Using Excel

                   Excel – sort and check
               

                   Excel formula
               

                   Sequential numbers and dates
               




Fraud detection using a database platform    EZ-R Stats, LLC
8 – Gaps

               Gap Testing - Example Results



             Start                          End            Missing

                     10789                        10791                      1

                     12523                        12526                      2

                     17546                        17548                      1



         Four check numbers are missing.



Fraud detection using a database platform                  EZ-R Stats, LLC
Next Metric
                             Outliers
                      1.
                             Stratification
                      2.
                             Day of Week
                      3.
                             Round Numbers
                      4.
                             Made Up Numbers
                      5.
                             Market basket
                      6.
                             Trends
                      7.
                             Gaps
                      8.
                             Duplicates
                      9.
                             Dates
                      10.


Fraud detection using a database platform      EZ-R Stats, LLC
9 - Duplicates

                         Duplicates


            Why is there more
               than one?
             Same, Same, Same, and
                Same, Same, Different

Fraud detection using a database platform    EZ-R Stats, LLC
9 – Duplicates

Two types of (related) tests


        Same items – same vendor, same invoice
    
        number, same invoice date, same amount
        Different items – same employee name,
    
        same city, different social security number




 Fraud detection using a database platform       EZ-R Stats, LLC
9 - Duplicates


        Duplicate Payments
             High payback area
         

          “Fuzzy”                logic
             Overriding software
         
             controls



Fraud detection using a database platform    EZ-R Stats, LLC
9 - Duplicates
Fuzzy matching with
software
               Levenshtein distance
          
               Soundex
          
               “Like” clause in SQL
          
                                                  Russian
               Regular expression                 physicist
          
               testing in SQL
               Vendor/employee
          
               situations


Fraud detection using a database platform    EZ-R Stats, LLC
9 - Duplicates


                       How is it done?

                  First, sort file in sequence for
              
                  testing
                  Compare items in consecutive
              
                  rows
                  Extract exceptions for follow-up
              




Fraud detection using a database platform    EZ-R Stats, LLC
9 - Duplicates

        Possible Duplicates - Example Results



           Vendor          Invoice Date     Invoice       Count
                                            Amount

                 10245         6/15/2007     3,544.78              4

                 10245         8/31/2007     2,010.37              2

                 17546         2/12/2007     1,500.00              2


       Five invoices may be duplicates.

Fraud detection using a database platform                EZ-R Stats, LLC
Next Metric

                         Outliers
                  1.
                         Stratification
                  2.
                         Day of Week
                  3.
                         Round Numbers
                  4.
                         Made Up Numbers
                  5.
                         Market basket
                  6.
                         Trends
                  7.
                         Gaps
                  8.
                         Duplicates
                  9.
                         Dates
                  10.

Fraud detection using a database platform   EZ-R Stats, LLC
10 - Dates

                   Date Checking

         If we’re closed, why
              is there …
              Adjusting journal entry?
                      Receiving report?
                      Payment issued?
Fraud detection using a database platform   EZ-R Stats, LLC
10 – Dates

          Holiday Date Testing
    Red Flag indicator





    Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates
   Date Testing challenges

       Difficult to determine
   

       Floating holidays –
   
       Friday, Saturday,
       Sunday, Monday




Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates
            Typical audit areas

            Journal entries
        

            Employee expense
        
            reports
            Business telephone calls
        

            Invoices
        

            Receiving reports
        

            Purchase orders
        




Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates

           Determination of Dates

           Transactions when business is
       
           closed
           Federal Office of Budget
       
           Management
           An excellent fraud indicator in
       
           some cases



Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates
          Holiday Date Testing

              Identifying holiday
          
              dates:
               – Error prone
               – Tedious

              U.S. only
          




Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates
                 Federal Holidays

          Established by Law
      

          Ten dates
      

          Specific date (unless
      
          weekend), OR
          Floating holiday
      




Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates

Federal Holiday Schedule

        Office of Personnel Management
   
        Example of specific date – Independence
   
        Day, July 4th (unless weekend)
        Example of floating date – Martin Luther
   
        King’s birthday (3rd Monday in January)
        Floating – Thanksgiving – 4th Thursday in
   
        November




 Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates

                 How it is done?

         Programmatically count holidays for
     
         entire population
         For each group, count holidays
     

         Compare the two histograms (group
     
         and population)
         Sort descending by metric (chi
     
         square/d-stat)

Fraud detection using a database platform     EZ-R Stats, LLC
10 – Dates

     Holiday Counts - Example Results

    Employee                    N           Chi Sq             D-stat
     Number
             10245                     37       5,234             0.9802
             32325                     23       4,735            0.97023
             17546                     18            476            0.321
             24135                     34            312          0.2189

        Two employees (10245 and 32325)
        were “off the chart” in terms of
        expense amounts incurred on a
        Federal Holiday.
Fraud detection using a database platform                  EZ-R Stats, LLC
Objective 3

The “Top 10” Metrics

                 Overview
          

                 Explain Each Metric
          

                 Examples of what it can detect
          

                 How to assess results
          




 Fraud detection using a database platform    EZ-R Stats, LLC
Objective 3 - Summarized


             Understand why and how
     1.
             Understand statistical basis for quantifying
     2.
             differences
             Identify ten general tools and techniques
     3.
             Understand examples done using Excel
     4.
             How pattern detection fits in
     5.


                   Next – using Excel …

Fraud detection using a database platform     EZ-R Stats, LLC
Objective 4

         Use of Excel

                Built-in functions
        

                Add-ins
        

                Macros
        

                Database access
        




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4

                  Excel templates
         Variety of tests
     
              Round numbers
          –

              Benford’s Law
          –

              Outliers
          –

              Etc.
          –




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4

Excel – Univariate statistics

            Work with Ranges
       

            =sum, =average, =stdevp
       

            =largest(Range,1),
       
            =smallest(Range,1)
            =min, =max, =count
       

            Tools | Data Analysis | Descriptive
       
            Statistics

 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4

                    Excel Histograms

           Tools | Data Analysis | Histogram
       

           Bin Range
       

           Data Range
       




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4

                  Excel Gaps testing


               Sort by sequential value
           
               =if(thiscell-lastcell <>
           
               1,thiscell-lastcell,0)
               Copy/paste special
           
               Sort
           




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4

Detecting duplicates with Excel

        Sort by sort values
    

        =if testing
    

        =if(=and(thiscell=lastcell, etc.))
    




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4

Performing audit tests with macros

              Repeatable process
          
              Audit standardization
          
              Learning curve
          
              Streamlining of tests
          
              More efficient and effective
          
              Examples -
          
              http://ezrstats.com/Macros/home.html



Fraud detection using a database platform    EZ-R Stats, LLC
Objective 4

Using database audit software

          Many “built-in” functions right off the shelf
      
          with SQL
          Control totals
      
          Exception identification
      
          “Drill down”
      
          Quantification
      
          June 2008 article in the EDP Audit &
      
          Control Journal (EDPACS) “SQL as an
          audit tool”
          http://ezrstats.com/doc/SQL_As_An_Audit_Tool.pdf
      


 Fraud detection using a database platform          EZ-R Stats, LLC
Objective 4

                    Use of Excel


                     Built-in functions
              

                     Add-ins
              

                     Macros
              

                     Database access
              




Fraud detection using a database platform   EZ-R Stats, LLC
Objective 4 - Summarized


             Understand why and how
      1.
             Understand statistical basis for quantifying
      2.
             differences
             Identify ten general tools and techniques
      3.
             Understand examples done using Excel
      4.
             How Pattern Detection fits in
      5.



                                Next – Fit …
Fraud detection using a database platform     EZ-R Stats, LLC
Objective 5

 How Pattern Detection Fits In


                   Business Analytics
           

                   Fraud Pattern Detection
           

                   Continuous monitoring
           




Fraud detection using a database platform    EZ-R Stats, LLC
Objective 5


Where does Fraud Pattern Detection fit in?


                  Right in the middle
                   Business Analytics
              

                   Fraud Pattern Detection
              

                   Continuous fraud pattern
              
                   detection
                   Continuous Monitoring
              


  Fraud detection using a database platform   EZ-R Stats, LLC
Objective 5



Business Analytics

             Fraud analytics -> business
         
             analytics
             Business analytics -> fraud
         
             analytics




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 5


Role in Continuous Monitoring (CM)


             Fraud analytics can feed (CM)
         

             Continuous fraud pattern detection
         

             Use output from CM to tune fraud
         
             pattern detection




 Fraud detection using a database platform   EZ-R Stats, LLC
Objective 5 - Summarized

            Understand why and how
     1.
            Understand statistical basis for quantifying
     2.
            differences
            Identify ten general tools and techniques
     3.
            Understand use of Excel
     4.
            How pattern detection fits in
     5.




                               Next: Links …
Fraud detection using a database platform    EZ-R Stats, LLC
Links for more information

         Kolmogorov-Smirnov
     

         http://tinyurl.com/y49sec
     

         Benford’s Law http://tinyurl.com/3qapzu
     

         Chi Square tests http://tinyurl.com/43nkdh
     

         Continuous monitoring
     
         http://tinyurl.com/3pltdl




Fraud detection using a database platform   EZ-R Stats, LLC
Market Basket

       Apriori testing for “ping ponging”
   
       Temple University
   
       http://tinyurl.com/5vax7r
       Apriori program (“open source”)
   
       http://tinyurl.com/5qehd5
       Article – “Medical ping ponging”
   
       http://tinyurl.com/5pzbh4


Fraud detection using a database platform   EZ-R Stats, LLC
Excel macros used in auditing

          Excel as an audit software
     
          http://tinyurl.com/6h3ye7
          Selected macros -
     
          http://ezrstats.com/Macros/home.html
          Spreadsheets forever -
     
          http://tinyurl.com/5ppl7t



Fraud detection using a database platform   EZ-R Stats, LLC
Questions?




Fraud detection using a database platform   EZ-R Stats, LLC
Contact info

 Phone:              (919)-219-1622
 E-mail:
  Mike.Blakley@ezrstats.com
 Blog: http://blog.ezrstats.com




 Fraud detection using a database platform   EZ-R Stats, LLC

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Fraud Detection Using A Database Platform

  • 1. Fraud Detection Using a Database Platform Mike Blakley Central Carolina Chapter of the Association of Certified Fraud February 23, 2009 Examiners Fraud Detetcion using a database platform EZ-R Stats, LLC
  • 2. Session objectives Understand why and how 1. Understand statistical basis for 2. quantifying differences Identify ten general tools and 3. techniques Understand how pattern 4. detection fits in Fraud detection using a database platform EZ-R Stats, LLC
  • 3. Session agenda and timings Managing the business risk of fraud (30 minutes)  Overview of statistical approach (10 min)  Discussion of databases (10 min)  Break (10 min)  Details of the approach (40 min)  Brief demo (5 min)  Open discussion and question and answer (15 min)  Fraud detection using a database platform EZ-R Stats, LLC
  • 4. Handout (CD) CD with articles and software  PowerPoint presentation  More info at www.ezrstats.com  Fraud detection using a database platform EZ-R Stats, LLC
  • 5. Optional quiz Test your understanding  Entirely optional  On home page under “events” – quiz  Results can be e-mailed  Fraud detection using a database platform EZ-R Stats, LLC
  • 6. “Cockroach” theory of auditing If you spot one roach….  Fraud detection using a database platform EZ-R Stats, LLC
  • 7. “Cockroach” theory of auditing There are probably 30  more that you don’t see… Fraud detection using a database platform EZ-R Stats, LLC
  • 8. Statistics based “roach” hunting Many frauds coulda/woulda/shoulda been detected with analytics Fraud detection using a database platform EZ-R Stats, LLC
  • 9. Overview Fraud patterns detectable with  digital analysis  Basis for digital analysis approach  Usage examples  Continuous monitoring  Business analytics Fraud detection using a database platform EZ-R Stats, LLC
  • 10. Objective 1 The Why and How Three brief examples  ACFE/IIA/AICPA Guidance Paper  Practice Advisory 2320-1  Auditors “Top 10”  Process Overview  Who, What, Why, When & Where  Fraud detection using a database platform EZ-R Stats, LLC
  • 11. Objective 1a Example 1 Wake County Transportation Fraud Supplier Kickback – School Bus  parts $5 million  Jail sentences  Period of years  Fraud detection using a database platform EZ-R Stats, LLC
  • 12. Objective 1a Too little too late Understaffed internal audit  Software not used  Data on multiple platforms  Transaction volumes large  Fraud detection using a database platform EZ-R Stats, LLC
  • 13. Objective 1a Preventable Need structured, objective  approach Let the data “talk to you”  Need efficient and effective  approach Fraud detection using a database platform EZ-R Stats, LLC
  • 14. Objective 1 Regression Analysis Stepwise to find  relationships Forwards – Backwards – Intervals  Confidence – Prediction – Fraud detection using a database platform EZ-R Stats, LLC
  • 15. Objective 1 Data outliers Sometimes an “out  and out Liar” But how do you  detect it? Fraud detection using a database platform EZ-R Stats, LLC
  • 16. Objective 1 Data Outliers Plot transportation costs vs.  number of buses “Drill down” on costs  Preventive maintenance – Fuel – Inspection – Fraud detection using a database platform EZ-R Stats, LLC
  • 17. Scatter plot with prediction and confidence intervals Fraud detection using a database platform EZ-R Stats, LLC
  • 18. Objective 1a Example 2 Cost of six types of AIDS drugs Total Cost of AIDS Drugs 200 150 NDC1 Dollar Amount NDC2 100 NDC3 50 NDC4 NDC5 0 NDC6 NDC1 NDC2 NDC3 NDC4 NDC5 NDC6 Drug Type Fraud detection using a database platform EZ-R Stats, LLC
  • 19. Objective 1 Medicare HIV Infusion Costs CMS Report for 2005  South Florida - $2.2 Billion  Rest of the country combined -  $.1 Billion Fraud detection using a database platform EZ-R Stats, LLC
  • 20. Objective 1 Pareto Chart Medicare HIV Infusion Costs - 2005 ($Billions) data source: HHS CMS 120.0% 100.0% Annual Medicare Costs 80.0% Pct 60.0% Cum Pct 40.0% 20.0% 0.0% 1 3 5 7 9 11 13 15 County Fraud detection using a database platform EZ-R Stats, LLC
  • 21. Objective 1a Example 2 Typical Prescription Patterns AIDS Drugs Prescription Patterns 60.0 NDC1 50.0 NDC2 40.0 Dollar Value NDC3 30.0 NDC4 20.0 NDC5 10.0 NDC6 0.0 Prov 1 Prov 2 Prov 3 Prov 4 Prov 5 Prov 6 Prescriber Fraud detection using a database platform EZ-R Stats, LLC
  • 22. Objective 1a Example 2 Prescriptions by Dr. X Dr. X compared with Total Population 350 300 250 Dollar Amount 200 Population 150 100 Dr. X 50 0 NDC1 NDC2 NDC3 NDC4 NDC5 NDC6 Drug Type Fraud detection using a database platform EZ-R Stats, LLC
  • 23. Objective 1a Example 2 Off-label use Serostim  Treat wasting syndrome, side effect of – AIDS, OR Used by body builders for recreational – purposes One physician prescribed $11.5 million – worth (12% of the entire state) Fraud detection using a database platform EZ-R Stats, LLC
  • 24. Objective 1a Example 3 Revenue trends Overall Revenue Trend 1.2 1.15 Annual Billings 1.1 Overall 1.05 Linear (Overall) 1 0.95 0.9 2001 2002 2003 Calendar Year Fraud detection using a database platform EZ-R Stats, LLC
  • 25. Example 3 Objective 1a Dental Billings Rapid Increase in Revenues 5 4 Annual Billings Billings A ($millions) 3 Billings B 2 Linear (Billings A) 1 0 2001 2002 2003 Calendar Year Fraud detection using a database platform EZ-R Stats, LLC
  • 26. Objective 1b Guidance Paper A proposed implementation approach  “Managing the Business Risk of Fraud: A  Practical Guide” http://tinyurl.com/3ldfza Five Principles  Fraud Detection  Coordinated Investigation Approach  Fraud detection using a database platform EZ-R Stats, LLC
  • 27. Objective 1b Managing the Business Risk of Fraud: A Practical Guide ACFE, IIA and AICPA  Exposure draft issued 11/2007, final 5/2008 Section 4 – Fraud  Detection Fraud detection using a database platform EZ-R Stats, LLC
  • 28. Guidance Paper Five Sections  Fraud Risk Governance – Fraud Risk Assessment – Fraud Prevention – Fraud Detection – Fraud Investigation and – corrective action Fraud detection using a database platform EZ-R Stats, LLC
  • 29. Risk Governance Fraud risk management program  Written policy – management’s expectations  regarding managing fraud risk Fraud detection using a database platform EZ-R Stats, LLC
  • 30. Risk Assessment Periodic review and assessment of potential  schemes and events Need to mitigate risk  Fraud detection using a database platform EZ-R Stats, LLC
  • 31. Fraud Prevention Establish prevention techniques  Mitigate possible impact on the organization  Fraud detection using a database platform EZ-R Stats, LLC
  • 32. Fraud Detection Establish detection techniques for fraud  “Back stop” where preventive measures fail,  or Unmitigated risks are realized  Fraud detection using a database platform EZ-R Stats, LLC
  • 33. Fraud Investigation and Corrective Action Reporting process to solicit input on fraud  Coordinated approach to investigation  Use of corrective action  Fraud detection using a database platform EZ-R Stats, LLC
  • 34. “60 Minutes” – “World of Trouble” 2/15/09 – Scott Pelley  Fraud Risk Governance – “one grand wink-wink, – nod-nod “ Fraud Risk Assessment - categorically false – Fraud Prevention – “my husband passed away” – Fraud Detection - We didn't know? Never saw one. – Fraud Investigation and corrective action - Pick-A- – Payment losses $36 billion Fraud detection using a database platform EZ-R Stats, LLC
  • 35. Objective 1b Section 4 – Fraud Detection Detective Controls  Process Controls  Anonymous Reporting  Internal Auditing  Proactive Fraud Detection  Fraud detection using a database platform EZ-R Stats, LLC
  • 36. Objective 1b Proactive Fraud Detection Data Analysis to identify:  – Anomalies – Trends – Risk indicators Fraud detection using a database platform EZ-R Stats, LLC
  • 37. Fraud Detective Controls Operate in the background  Not evident in everyday business  environment These techniques usually –  Occur in ordinary course of business – Corroboration using external information – Automatically communicate deficiencies – Use results to enhance other controls – Fraud detection using a database platform EZ-R Stats, LLC
  • 38. Examples of detective controls Whistleblower hot-lines (DHHS and OSA  have them) Process controls (Medicaid audits and edits)  Proactive fraud detection procedures  Data analysis – Continuous monitoring – Benford’s Law – Fraud detection using a database platform EZ-R Stats, LLC
  • 39. Objective 1b Specific Examples Cited Journal entries – suspicious  transactions Identification of relationships  Benford’s Law  Continuous monitoring  Fraud detection using a database platform EZ-R Stats, LLC
  • 40. Objective 1b Data Analysis enhances ability to detect fraud Identify hidden relationships  Identify suspicious transactions  Assess effectiveness of internal  controls Monitor fraud threats  Analyze millions of transactions  Fraud detection using a database platform EZ-R Stats, LLC
  • 41. Continuous Monitoring of Fraud Detection Organization should develop ongoing  monitoring and measurements Establish measurement criteria (and  communicate to Board) Measurable criteria include:  Fraud detection using a database platform EZ-R Stats, LLC
  • 42. Measurable Criteria – number of fraud allegations  fraud investigations resolved  Employees attending annual ethics course  Whistle blower allegations  Messages supporting ethical behavior  delivered by executives Vendors signing ethical behavior standards  Fraud detection using a database platform EZ-R Stats, LLC
  • 43. Management ownership of each technique implemented Each process owner should:  Evaluate effectiveness of technique regularly – Adjust technique as required – Document adjustments – Report modifications needed for techniques which – become less effective Fraud detection using a database platform EZ-R Stats, LLC
  • 44. Practice Advisory 2320-1 Analysis and Evaluation International standards for the professional  practice of Internal Auditing Analytical audit procedures  Efficient and effective – Useful in detecting – Differences that are not expected  Potential errors  Potential irregularities  Fraud detection using a database platform EZ-R Stats, LLC
  • 45. Analytical Audit Procedures May include  – Study of relationships – Comparison of amounts with similar information in the organization – Comparison of amounts with similar information in the industry Fraud detection using a database platform EZ-R Stats, LLC
  • 46. Analytical audit procedures Performed using monetary amounts, physical  quantities, ratios or percentages Ratio, trend and regression analysis  Period to period comparisons  Auditors should use analytical audit  procedures in planning the engagement Fraud detection using a database platform EZ-R Stats, LLC
  • 47. Factors to consider Significance of the area being audited  Assessment of risk  Adequacy of system of internal control  Availability and reliability of information  Extent to which procedures provide support  for engagement results Fraud detection using a database platform EZ-R Stats, LLC
  • 48. Objective 1c Peeling the Onion Fraud Items Possible Error Conditions Population as Whole Fraud detection using a database platform EZ-R Stats, LLC
  • 49. Objective 1d Fraud Pattern Detection Round Numbers Benford’s Law Market Basket Stratification Gaps Target Group Trend Line Univariate Duplicates Holiday Day of Week Fraud detection using a database platform EZ-R Stats, LLC
  • 50. Objective 1e Digital Analysis (5W) Who   What  Why  Where  When Fraud detection using a database platform EZ-R Stats, LLC
  • 51. Objective 1e Who Uses Digital Analysis Traditionally, IT specialists  With appropriate tools, audit  generalists (CAATs) Growing trend of business  analytics Essential component of  continuous monitoring Fraud detection using a database platform EZ-R Stats, LLC
  • 52. Objective 1e What - Digital Analysis Using software to:  Classify – Quantify – Compare – Both numeric and non-numeric  data Fraud detection using a database platform EZ-R Stats, LLC
  • 53. Objective 1e How - Assessing fraud risk Basis is quantification  Software can do the “leg work”  Statistical measures of difference  – Chi square – Kolmogorov-Smirnov – D-statistic Specific approaches  Fraud detection using a database platform EZ-R Stats, LLC
  • 54. Objective 1e Why - Advantages Automated process  Handle large data populations  Objective, quantifiable metrics  Can be part of continuous monitoring  Can produce useful business analytics  100% testing is possible  Quantify risk  Repeatable process  Fraud detection using a database platform EZ-R Stats, LLC
  • 55. Objective 1e Why - Disadvantages Costly (time and software costs)  Learning curve  Requires specialized knowledge  Fraud detection using a database platform EZ-R Stats, LLC
  • 56. Objective 1e When to Use Digital Analysis Traditional – intermittent (one off)  Trend is to use it as often as possible  Continuous monitoring  Scheduled processing  Fraud detection using a database platform EZ-R Stats, LLC
  • 57. Objective 1e Where Is It Applicable? Any organization with data in digital  format, and especially if: Volumes are large – Data structures are complex – Potential for fraud exists – Fraud detection using a database platform EZ-R Stats, LLC
  • 58. Objective 1 Objective 1 Summarized Three brief examples  CFE Guidance Paper  “Top 10” Metrics  Process Overview  Who, What, Why, When & Where  Fraud detection using a database platform EZ-R Stats, LLC
  • 59. Objective 1 - Summarized Understand why and how 1. Understand statistical basis for quantifying 2. differences Identify ten general tools and techniques 3. Understand use of Excel 4. How pattern detection fits in 5. Next is the basis … Fraud detection using a database platform EZ-R Stats, LLC
  • 60. Objective 2 Basis for Pattern Detection Analytical review  Isolate the “significant few”  Detection of errors  Quantified approach  Fraud detection using a database platform EZ-R Stats, LLC
  • 61. Objective 2 Understanding the Basis Quantified Approach  Population vs. Groups  Measuring the Difference  Stat 101 – Counts, Totals, Chi  Square and K-S The metrics used  Fraud detection using a database platform EZ-R Stats, LLC
  • 62. Objective 2a Quantified Approach Based on measureable  differences  Population vs. Group  “Shotgun” technique Fraud detection using a database platform EZ-R Stats, LLC
  • 63. Objective 2a Detection of Fraud Characteristics Something is different than expected  Fraud detection using a database platform EZ-R Stats, LLC
  • 64. Objective 2b Fraud patterns Common theme – “something is  different”  Groups  Group pattern is different than overall population Fraud detection using a database platform EZ-R Stats, LLC
  • 65. Objective 2c Measurement Basis  Transaction counts  Transaction amounts Fraud detection using a database platform EZ-R Stats, LLC
  • 66. Objective 2d A few words about statistics (the “s” word) Detailed knowledge of statistics not  necessary Software packages do the “number-  crunching” Statistics used only to highlight  potential errors/frauds Not used for quantification  Fraud detection using a database platform EZ-R Stats, LLC
  • 67. Objective 2d How is digital analysis done? Comparison of group with population as a  whole Can be based on either counts or amounts  Difference is measured  Groups can then be ranked using a selected  measure High difference = possible error/fraud  Fraud detection using a database platform EZ-R Stats, LLC
  • 68. Demo in Excel of the process Based roughly on the Wake County  Transportation fraud Illustrates how the process works, using  Excel Fraud detection using a database platform EZ-R Stats, LLC
  • 69. Objective 2d Histograms Attributes tallied and categorized into “bins”  Counts or sums of amounts  Fraud detection using a database platform EZ-R Stats, LLC
  • 70. Objective 2d Two histograms obtained Population and group  Population Group 700 80 600 70 60 500 50 400 40 300 30 200 20 100 10 0 0 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 07 Fraud detection using a database platform EZ-R Stats, LLC
  • 71. Objective 2d Histograms Attributes tallied and categorized into “bins”  Counts or sums of amounts  Fraud detection using a database platform EZ-R Stats, LLC
  • 72. Objective 2d Compute Cumulative Amount for each Count by Month Cum Pct 80 120.0% 70 100.0% 60 50 80.0% Count 40 60.0% 30 20 40.0% 10 20.0% 0 Au 07 Ju 7 Fe 7 Ju 7 Ap 7 07 M 07 O7 De 7 No 07 Se 7 0.0% M7 -0 -0 0 0 0 n-0 0 r-0 l- c- p- v- n- b- ct- g- ay ar Ja 7 07 07 07 7 07 l-0 -0 M onth p- - n- - ov ay ar Ju Ja Se M N M Fraud detection using a database platform EZ-R Stats, LLC
  • 73. Objective 2d Are the histograms different? Two statistical measures of  difference Chi Squared (counts)  K-S (distribution)  Both yield a difference metric  Fraud detection using a database platform EZ-R Stats, LLC
  • 74. Objective 2d Chi Squared Classic test on data in a table  Answers the question – are the  rows/columns different Some limitations on when it can be  applied Fraud detection using a database platform EZ-R Stats, LLC
  • 75. Objective 2d Chi Squared Table of Counts  Degrees of Freedom  Chi Squared Value  P-statistic  Computationally intensive  Fraud detection using a database platform EZ-R Stats, LLC
  • 76. Objective 2d Kolmogorov-Smirnov Two Russian  mathematicians  Comparison of distributions  Metric is the “d-statistic” Fraud detection using a database platform EZ-R Stats, LLC
  • 77. Objective 2d How is K-S test done? Four step process  For each cluster element 1. determine percentage Then calculate cumulative 2. percentage Compare the differences in 3. cumulative percentages Identify the largest difference 4. Fraud detection using a database platform EZ-R Stats, LLC
  • 78. Objective 2d - KS Kolmogorov-Smirnov Fraud detection using a database platform EZ-R Stats, LLC
  • 79. Objective 2e Classification by metrics Stratification  Day of week  Happens on holiday  Round numbers  Variability  Benford’s Law  Trend lines  Relationships (market basket)  Gaps  Duplicates  Fraud detection using a database platform EZ-R Stats, LLC
  • 80. Objective e Auditor’s “Top 10” Metrics Outliers / Variability 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 81. Objective 2 Understanding the Basis Quantified Approach  Population vs. Groups  Measuring the Difference  Stat 101 – Counts, Totals, Chi Square  and K-S The metrics used  Fraud detection using a database platform EZ-R Stats, LLC
  • 82. Objective 2 - Summarized Understand why and how 1. Understand statistical basis for quantifying 2. differences Identify ten general tools and techniques 3. Understand examples done using Excel 4. How pattern detection fits in 5. Next are the metrics … Fraud detection using a database platform EZ-R Stats, LLC
  • 83. It’s that time! Session Break! Fraud detection using a database platform EZ-R Stats, LLC
  • 84. Objective 3 The “Top 10” Metrics Overview  Explain Each Metric  Examples of what it can detect  How to assess results  Fraud detection using a database platform EZ-R Stats, LLC
  • 85. Objective 3 Trapping anomalies Fraud detection using a database platform EZ-R Stats, LLC
  • 86. Objective 3 Fraud Pattern Detection Round Numbers Benford’s Law Market Basket Stratification Gaps Target Group Trend Line Univariate Duplicates Holiday Day of Week Fraud detection using a database platform EZ-R Stats, LLC
  • 87. 1 - Outliers Outliers / Variability Outliers are amounts which are significantly different from the rest of the population Fraud detection using a database platform EZ-R Stats, LLC
  • 88. 1 - Outliers Outliers / Variability Charting (visual)  Software to analyze “z-scores”  Top and Bottom 10, 20 etc.  High and low variability (coefficient  of variation) Fraud detection using a database platform EZ-R Stats, LLC
  • 89. 1 - Outliers Drill down to the group level Basic statistics  – Minimum, maximum and average – Variability Sort by statistic of interest  – Variability (coefficient of variation) – Maximum, etc. Fraud detection using a database platform EZ-R Stats, LLC
  • 90. 1 - Outliers Example Results Provider N Coeff Var 3478421 3,243 342.23 2356721 4,536 87.23 3546789 3,421 23.25 5463122 2,311 18.54 Two providers (3478421 and 2356721) had significantly more variability in the amounts of their claims than all the rest. Fraud detection using a database platform EZ-R Stats, LLC
  • 91. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 92. 2 - Stratification Unusual stratification patterns Do you know how your data looks? Fraud detection using a database platform EZ-R Stats, LLC
  • 93. 2 - Stratification Stratification - How Charting (visual)   Chi Squared  Kolmogorov-Smirnov  By groups Fraud detection using a database platform EZ-R Stats, LLC
  • 94. 2 – Stratification Purpose / types of errors Transactions out of the ordinary  “Up-coding” insurance claims  “Skewed” groupings  Based on either count or amount  Fraud detection using a database platform EZ-R Stats, LLC
  • 95. 2 – Stratification The process? Stratify the entire population into 1. “bins” specified by auditor Same stratification on each group 2. (e.g. vendor) Compare the group tested to the 3. population Obtain measure of difference for each 4. group Sort descending on difference 5. measure Fraud detection using a database platform EZ-R Stats, LLC
  • 96. 2 – Stratification Units of Service Stratified - Example Results Provider N Chi Sq D-stat 2735211 6,011 7,453 0.8453 4562134 8,913 5,234 0.7453 4321089 3,410 342 0.5231 4237869 2,503 298 0.4632 Two providers (2735211 and 4562134) are shown to be much different from the overall population (as measured by Chi Square). Fraud detection using a database platform EZ-R Stats, LLC
  • 97. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 98. 3 – Day of Week Day of Week Activity on weekdays  Activity on weekends  Peak activity mid to late week  Fraud detection using a database platform EZ-R Stats, LLC
  • 99. 3 – Day of Week Purpose / Type of Errors Identify unusually high/low  activity on one or more days of week Dentist who only handled  Medicaid on Tuesday Office is empty on Friday  Fraud detection using a database platform EZ-R Stats, LLC
  • 100. How it is done? Programmatically check entire population  Obtain counts and sums by day of week  (1-7) Prepare histogram  For each group do the same procedure  Compare the two histograms  Sort descending by metric (chi square/d-  stat) Fraud detection using a database platform EZ-R Stats, LLC
  • 101. 3 – Day of Week Day of Week - Example Results Provider N Chi Sq D-stat 2735211 5,404 12,435 0.9802 4562134 5,182 7,746 0.8472 4321089 5,162 87 0.321 4237869 7,905 56 0.2189 Provider 2735211 only provided service for Medicaid on Tuesdays. Provider 4562134 was closed on Thursdays and Fridays. Fraud detection using a database platform EZ-R Stats, LLC
  • 102. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 103. 4 – Round Numbers Round Numbers It’s about…. Estimates! Fraud detection using a database platform EZ-R Stats, LLC
  • 104. 4 – Round Numbers Purpose / Type of Errors Isolate estimates  Highlight account numbers in  journal entries with round numbers Split purchases (“under the radar”)  Which groups have the most  estimates Fraud detection using a database platform EZ-R Stats, LLC
  • 105. 4 – Round Numbers Round numbers Classify population amounts  – $1,375.23 is not round – $5,000 is a round number – type 3 (3 zeros) – $10,200 is a round number type 2 (2 zeros) Quantify expected vs. actual (d-statistic)  Generally represents an estimate  Journal entries  Fraud detection using a database platform EZ-R Stats, LLC
  • 106. 4 – Round Numbers Round Numbers in Journal Entries - Example Results Account N Chi Sq D-stat 2735211 4,136 54,637 0.9802 4562134 833 35,324 0.97023 4321089 8,318 768 0.321 4237869 9,549 546 0.2189 Two accounts, 2735211 and 4562134 have significantly more round number postings than any other posting account in the journal entries. Fraud detection using a database platform EZ-R Stats, LLC
  • 107. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 108. 5 – Made up numbers Made up Numbers Curb stoning Imaginary numbers Benford’s Law Fraud detection using a database platform EZ-R Stats, LLC
  • 109. 5 – Made Up Numbers What can be detected Made up numbers –  e.g. falsified inventory counts, tax return schedules Fraud detection using a database platform EZ-R Stats, LLC
  • 110. 5 – Made Up Numbers Benford’s Law using Excel Basic formula is “=log(1+(1/N))”  Workbook with formulae available at  http://tinyurl.com/4vmcfs Obtain leading digits using “Left”  function, e.g. left(Cell,1) Fraud detection using a database platform EZ-R Stats, LLC
  • 111. 5 – Made Up Numbers Made up numbers Benford’s Law  Check Chi Square and d-statistic  First 1,2,3 digits  Last 1,2 digits  Second digit  Sources for more info  Fraud detection using a database platform EZ-R Stats, LLC
  • 112. 5 – Made Up Numbers How is it done? Decide type of test – (first 1-3 digits, last  1-2 digit etc) For each group, count number of  observations for each digit pattern Prepare histogram  Based on total count, compute expected  values For the group, compute Chi Square and  d-stat Sort descending by metric (chi square/d-  stat) Fraud detection using a database platform EZ-R Stats, LLC
  • 113. 5 – Made Up Numbers Invoice Amounts tested with Benford’s law - Example Results Store Hi Digit Chi Sq D-stat 324 79 5,234 0.9802 563 89 4,735 0.97023 432 23 476 0.321 217 74 312 0.2189 During tests of invoices by store, two stores, 324 and 563 have significantly more differences than any other store as measured by Benford’s Law. Fraud detection using a database platform EZ-R Stats, LLC
  • 114. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 115. 6 – Market Basket Market Basket Medical “Ping ponging”  Pattern associations  Apriori program  References at end of slides  Apriori – Latin a (from) priori  (former) Deduction from the known  Fraud detection using a database platform EZ-R Stats, LLC
  • 116. 6 – Market basket Purpose / Type of Errors Unexpected patterns and  associations Based on “market basket” concept  Unusual combinations of diagnosis  code on medical insurance claim Fraud detection using a database platform EZ-R Stats, LLC
  • 117. 6 – Market basket Market Basket JE Accounts   JE Approvals  Credit card fraud in Japan – taxi and ATM Fraud detection using a database platform EZ-R Stats, LLC
  • 118. 6 – Market basket How is it done? First, identify groups, e.g. all  medical providers for a patient Next, for each provider, assign a  unique integer value Create a text file containing the  values Run “apriori” analysis  Fraud detection using a database platform EZ-R Stats, LLC
  • 119. 6 – Market basket Apriori outputs For each unique value, probability of  other values If you see Dr. Jones, you will also  see Dr. Smith (80% probability) If you see a JE to account ABC, there  will also an entry to account XYZ (30%) Fraud detection using a database platform EZ-R Stats, LLC
  • 120. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 121. 7 - Trends Trend Busters Does the pattern make sense? ACME Technology 30,000 25,000 20,000 Amount Sales 15,000 Em ployee Count 10,000 5,000 0 7 8 7 M8 7 07 7 08 7 -0 -0 -0 -0 l-0 0 0 v- n- n- p- ay ay ar ar Ju No Ja Ja Se M M M Date Fraud detection using a database platform EZ-R Stats, LLC
  • 122. 7 – Trends Trend Busters Linear regression  Sales are up, but cost of goods sold is  down “Spikes”  Fraud detection using a database platform EZ-R Stats, LLC
  • 123. 7 – Trends Purpose / Type of Errors Identify trend lines, slopes,  etc. Correlate trends  Identify anomalies  Key punch errors where  amount is order of magnitude Fraud detection using a database platform EZ-R Stats, LLC
  • 124. 7 – Trends Linear Regression  Test relationships (e.g. invoice amount and sales tax)  Perform multi-variable analysis Fraud detection using a database platform EZ-R Stats, LLC
  • 125. 7 – Trends How is it done? Estimate linear trends using “best  fit” Measure variability (standard  errors) Measure slope  Sort descending by slope,  variability, etc. Fraud detection using a database platform EZ-R Stats, LLC
  • 126. 7 – Trends Trend Lines by Account - Example Results Account N Slope Std Err 32451 18 1.230 0.87 43517 17 1.070 4.3 32451 27 1.023 0.85 43517 32 1.010 0.36 43870 23 0.340 2.36 54630 56 -0.560 1.89 Generally the trend is gently sloping up, but two accounts (43870 and 54630) are different. Fraud detection using a database platform EZ-R Stats, LLC
  • 127. Scatter plot with prediction and confidence intervals Fraud detection using a database platform EZ-R Stats, LLC
  • 128. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 129. 8 - Gaps Numeric Sequence Gaps What’s there is interesting, what’s not there is critical … Fraud detection using a database platform EZ-R Stats, LLC
  • 130. 8 – Gaps Purpose / Type of Errors Missing documents (sales, cash,  etc.) Inventory losses (missing receiving  reports) Items that “walked off”  Fraud detection using a database platform EZ-R Stats, LLC
  • 131. 8 – Gaps How is it done? Check any sequence of numbers  supposed to be complete, e.g. Cash receipts  Sales slips  Purchase orders  Fraud detection using a database platform EZ-R Stats, LLC
  • 132. 8 – Gaps Gaps Using Excel Excel – sort and check  Excel formula  Sequential numbers and dates  Fraud detection using a database platform EZ-R Stats, LLC
  • 133. 8 – Gaps Gap Testing - Example Results Start End Missing 10789 10791 1 12523 12526 2 17546 17548 1 Four check numbers are missing. Fraud detection using a database platform EZ-R Stats, LLC
  • 134. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 135. 9 - Duplicates Duplicates Why is there more than one? Same, Same, Same, and Same, Same, Different Fraud detection using a database platform EZ-R Stats, LLC
  • 136. 9 – Duplicates Two types of (related) tests Same items – same vendor, same invoice  number, same invoice date, same amount Different items – same employee name,  same city, different social security number Fraud detection using a database platform EZ-R Stats, LLC
  • 137. 9 - Duplicates Duplicate Payments High payback area   “Fuzzy” logic Overriding software  controls Fraud detection using a database platform EZ-R Stats, LLC
  • 138. 9 - Duplicates Fuzzy matching with software Levenshtein distance  Soundex  “Like” clause in SQL  Russian Regular expression physicist  testing in SQL Vendor/employee  situations Fraud detection using a database platform EZ-R Stats, LLC
  • 139. 9 - Duplicates How is it done? First, sort file in sequence for  testing Compare items in consecutive  rows Extract exceptions for follow-up  Fraud detection using a database platform EZ-R Stats, LLC
  • 140. 9 - Duplicates Possible Duplicates - Example Results Vendor Invoice Date Invoice Count Amount 10245 6/15/2007 3,544.78 4 10245 8/31/2007 2,010.37 2 17546 2/12/2007 1,500.00 2 Five invoices may be duplicates. Fraud detection using a database platform EZ-R Stats, LLC
  • 141. Next Metric Outliers 1. Stratification 2. Day of Week 3. Round Numbers 4. Made Up Numbers 5. Market basket 6. Trends 7. Gaps 8. Duplicates 9. Dates 10. Fraud detection using a database platform EZ-R Stats, LLC
  • 142. 10 - Dates Date Checking If we’re closed, why is there … Adjusting journal entry? Receiving report? Payment issued? Fraud detection using a database platform EZ-R Stats, LLC
  • 143. 10 – Dates Holiday Date Testing Red Flag indicator  Fraud detection using a database platform EZ-R Stats, LLC
  • 144. 10 – Dates Date Testing challenges Difficult to determine  Floating holidays –  Friday, Saturday, Sunday, Monday Fraud detection using a database platform EZ-R Stats, LLC
  • 145. 10 – Dates Typical audit areas Journal entries  Employee expense  reports Business telephone calls  Invoices  Receiving reports  Purchase orders  Fraud detection using a database platform EZ-R Stats, LLC
  • 146. 10 – Dates Determination of Dates Transactions when business is  closed Federal Office of Budget  Management An excellent fraud indicator in  some cases Fraud detection using a database platform EZ-R Stats, LLC
  • 147. 10 – Dates Holiday Date Testing Identifying holiday  dates: – Error prone – Tedious U.S. only  Fraud detection using a database platform EZ-R Stats, LLC
  • 148. 10 – Dates Federal Holidays Established by Law  Ten dates  Specific date (unless  weekend), OR Floating holiday  Fraud detection using a database platform EZ-R Stats, LLC
  • 149. 10 – Dates Federal Holiday Schedule Office of Personnel Management  Example of specific date – Independence  Day, July 4th (unless weekend) Example of floating date – Martin Luther  King’s birthday (3rd Monday in January) Floating – Thanksgiving – 4th Thursday in  November Fraud detection using a database platform EZ-R Stats, LLC
  • 150. 10 – Dates How it is done? Programmatically count holidays for  entire population For each group, count holidays  Compare the two histograms (group  and population) Sort descending by metric (chi  square/d-stat) Fraud detection using a database platform EZ-R Stats, LLC
  • 151. 10 – Dates Holiday Counts - Example Results Employee N Chi Sq D-stat Number 10245 37 5,234 0.9802 32325 23 4,735 0.97023 17546 18 476 0.321 24135 34 312 0.2189 Two employees (10245 and 32325) were “off the chart” in terms of expense amounts incurred on a Federal Holiday. Fraud detection using a database platform EZ-R Stats, LLC
  • 152. Objective 3 The “Top 10” Metrics Overview  Explain Each Metric  Examples of what it can detect  How to assess results  Fraud detection using a database platform EZ-R Stats, LLC
  • 153. Objective 3 - Summarized Understand why and how 1. Understand statistical basis for quantifying 2. differences Identify ten general tools and techniques 3. Understand examples done using Excel 4. How pattern detection fits in 5. Next – using Excel … Fraud detection using a database platform EZ-R Stats, LLC
  • 154. Objective 4 Use of Excel Built-in functions  Add-ins  Macros  Database access  Fraud detection using a database platform EZ-R Stats, LLC
  • 155. Objective 4 Excel templates Variety of tests  Round numbers – Benford’s Law – Outliers – Etc. – Fraud detection using a database platform EZ-R Stats, LLC
  • 156. Objective 4 Excel – Univariate statistics Work with Ranges  =sum, =average, =stdevp  =largest(Range,1),  =smallest(Range,1) =min, =max, =count  Tools | Data Analysis | Descriptive  Statistics Fraud detection using a database platform EZ-R Stats, LLC
  • 157. Objective 4 Excel Histograms Tools | Data Analysis | Histogram  Bin Range  Data Range  Fraud detection using a database platform EZ-R Stats, LLC
  • 158. Objective 4 Excel Gaps testing Sort by sequential value  =if(thiscell-lastcell <>  1,thiscell-lastcell,0) Copy/paste special  Sort  Fraud detection using a database platform EZ-R Stats, LLC
  • 159. Objective 4 Detecting duplicates with Excel Sort by sort values  =if testing  =if(=and(thiscell=lastcell, etc.))  Fraud detection using a database platform EZ-R Stats, LLC
  • 160. Objective 4 Performing audit tests with macros Repeatable process  Audit standardization  Learning curve  Streamlining of tests  More efficient and effective  Examples -  http://ezrstats.com/Macros/home.html Fraud detection using a database platform EZ-R Stats, LLC
  • 161. Objective 4 Using database audit software Many “built-in” functions right off the shelf  with SQL Control totals  Exception identification  “Drill down”  Quantification  June 2008 article in the EDP Audit &  Control Journal (EDPACS) “SQL as an audit tool” http://ezrstats.com/doc/SQL_As_An_Audit_Tool.pdf  Fraud detection using a database platform EZ-R Stats, LLC
  • 162. Objective 4 Use of Excel Built-in functions  Add-ins  Macros  Database access  Fraud detection using a database platform EZ-R Stats, LLC
  • 163. Objective 4 - Summarized Understand why and how 1. Understand statistical basis for quantifying 2. differences Identify ten general tools and techniques 3. Understand examples done using Excel 4. How Pattern Detection fits in 5. Next – Fit … Fraud detection using a database platform EZ-R Stats, LLC
  • 164. Objective 5 How Pattern Detection Fits In Business Analytics  Fraud Pattern Detection  Continuous monitoring  Fraud detection using a database platform EZ-R Stats, LLC
  • 165. Objective 5 Where does Fraud Pattern Detection fit in? Right in the middle Business Analytics  Fraud Pattern Detection  Continuous fraud pattern  detection Continuous Monitoring  Fraud detection using a database platform EZ-R Stats, LLC
  • 166. Objective 5 Business Analytics Fraud analytics -> business  analytics Business analytics -> fraud  analytics Fraud detection using a database platform EZ-R Stats, LLC
  • 167. Objective 5 Role in Continuous Monitoring (CM) Fraud analytics can feed (CM)  Continuous fraud pattern detection  Use output from CM to tune fraud  pattern detection Fraud detection using a database platform EZ-R Stats, LLC
  • 168. Objective 5 - Summarized Understand why and how 1. Understand statistical basis for quantifying 2. differences Identify ten general tools and techniques 3. Understand use of Excel 4. How pattern detection fits in 5. Next: Links … Fraud detection using a database platform EZ-R Stats, LLC
  • 169. Links for more information Kolmogorov-Smirnov  http://tinyurl.com/y49sec  Benford’s Law http://tinyurl.com/3qapzu  Chi Square tests http://tinyurl.com/43nkdh  Continuous monitoring  http://tinyurl.com/3pltdl Fraud detection using a database platform EZ-R Stats, LLC
  • 170. Market Basket Apriori testing for “ping ponging”  Temple University  http://tinyurl.com/5vax7r Apriori program (“open source”)  http://tinyurl.com/5qehd5 Article – “Medical ping ponging”  http://tinyurl.com/5pzbh4 Fraud detection using a database platform EZ-R Stats, LLC
  • 171. Excel macros used in auditing Excel as an audit software  http://tinyurl.com/6h3ye7 Selected macros -  http://ezrstats.com/Macros/home.html Spreadsheets forever -  http://tinyurl.com/5ppl7t Fraud detection using a database platform EZ-R Stats, LLC
  • 172. Questions? Fraud detection using a database platform EZ-R Stats, LLC
  • 173. Contact info  Phone: (919)-219-1622  E-mail: Mike.Blakley@ezrstats.com  Blog: http://blog.ezrstats.com Fraud detection using a database platform EZ-R Stats, LLC