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Please view the slide, it depicts the February 2017 edition of our very informative Newsletter.
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February 2017 newsletter
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ISSUE 2 | VOL 2 | FEBRUARY | YEAR 2017 Employee Fraud……………………1
Employee Fraud: The enemy
Amongst us, moving from problem
To Solutions………………………..2
Types of Fraud………………….….3
Word Search………………………. 4
Upcoming & Recommended
Events ……………………………...5-6
Experts Articles…………………….7
KAW"ESTABLISHING RELATIONSHIPS BUILT ON TRUST"
“A check up a day can keep Employee
Fraud away! Why prevention is better
than cure.”
Employee Fraud is an attempt to commit fraud against a company or organization that the employee is working for. It
is actually the fastest growing and one of the most costly crimes in the world. Many of you reading this article would
have already fallen victim of Employee Fraud or would have witnessed one or more Employee Fraud incidents. If you
have not, you either don't realize you have, or you do not understand the red flags or it is just a matter of time.
Employee Fraud is a major concern for organizations locally, regionally and worldwide. The need to implement and
enhance internal controls in our businesses is more critical than ever. Internal Auditors and HR Professionals, in
particular, play a crucial role in detecting and preventing Fraud during their internal assessment process, recruitment, as
well as, enforcing ethical policies in the workplace. A business can lose millions in revenues to Fraud simply because
employees are not pre-screened properly during his/her interview during the employment process or they are not being
monitored and assessed during the course of employment. Sometimes our businesses encourages Employee Fraud by
simply not putting internal controls or Anti-Fraud Programs in place.
In some cases, the crime may be so small it forever goes unnoticed or turns out to be the catastrophic blow a business
never recovers from. KAW Management Services Limited can help you and your business to conduct and implement
Anti-Fraud Assessments, build Anti-Fraud Programs that will assist you in identifying Fraud Risk Areas and also
minimize or curtail Fraud in your organizations. We are passionate about educating businesses and individuals so that
they can be more aware of the various scams and schemes so commonly carried out in workplace. Billions are stolen
from governments and businesses worldwide every year based on statistics. If someone really wants to steal from you,
they will figure out a way to do so and try to hide it or cover their tracks. Our recommendations are not to cure Fraud,
but if implemented by Boards and Management, they can certainly help to minimize or make it difficult to happen.
Contact us at KAW and we will be ready to assist. Remember that any comments and queries can be sent to us at
training@kawmanagement.com; training.kawmgmt@candw.ag or info@kawmanagement.com or visit our website at
www.kawmanagement.com.
2. 2 | P a g e
“A check up a day can keep Employee Fraud
away! Why prevention is better than cure.”
Employee Fraud can be a major problem for businesses especially small ones that cannot sustain the revenue loss
shock. Undetected Employee Fraud can cause serious financial damage to a business, as well as, reputational risk
and loss in employee morale. There are many different types of Employee Fraud, including misuse of company
assets, corruption, money laundering, embezzlement, to name a few.
Misuse of assets is one of the most common forms of Employee Fraud, because it can come in so many ways. The
use of company supplies for personal use, such as simply creating fictitious debits, submitting false expense claims,
or browsing the internet when you should be working and working with customers and supplies in order to get a
kickback, are just a few. Employers can do a lot to protect themselves against this type of fraud by creating a culture
of ethics, setting the tone from the top, increasing vigilance and security, having proper pre-screening and ongoing
monitoring of employees and reducing the opportunities for fraud occurrence through the implementation of strong
internal controls. Educating employees can also help. In many cases, individuals are seriously unaware that basic
little acts that they are involved in are actually fraudulent.
Corruption may sound like a harsh crime reserved for politicians, but it can be a form of Employee Fraud, as well.
Corruption often occurs when an employee offers discounts, services or preferential treatment in return for personal
profitable gain from an outside individual or business without approval from their superiors and not following
policies and procedures.
Employee Fraud is a serious and costly problem throughout the business world, and can occur within any business
or organization, whether small or large. The Fraud Triangle demonstrates that for a fraud to occur there must be
opportunity, an employee has a motive or under pressure and then they simply rationalize. These three factors
explain how and why employees commit fraud. Employers can do a lot to minimize or prevent Employee Fraud by
attempting to remove the arm of the triangle call “Opportunity”.
KAW Management Service Ltd. specializes in Anti-Fraud Services that can prepare and provide solutions in combating
Employment Fraud. If you need advice, KAW Management Service Ltd. can provide you with superior service to ensure
that your business and information stay secure and safe.
3. 3 | P a g e
Types of Fraud Investigated by the Office of the Inspector General
By: Catherine Leahy Scott
Inspector General
In addressing fraud within the workers' compensation system, the Office of the Inspector General conducts
investigations into the following types of fraudulent conduct:
Employee Fraud
Occurs when an employee knowingly and intentionally misrepresents, or causes another to misrepresent a material
fact about an injury for the purpose of obtaining, or helping another obtain workers' compensation benefits to which
they are not otherwise entitled. The misrepresentation must be knowingly made as an inadvertent or unintentional
misstatement is not fraud. The misrepresentation must have been made for the purpose of obtaining or denying
benefits, and important enough to impact upon receipt of those benefits. For example, a misrepresentation by an
employee that they were 25 years of age when, in fact, they were 22 years of age would not be a material
misrepresentation constituting fraud unless the age difference was somehow significant to the claimed injury and to
the determination of workers' compensation benefits.
Examples of Employee Fraud
Filing a claim for an injury that did not occur on, or has no relation to the job.
Lying about work status when questioned directly, such as at a deposition or a hearing, while receiving
temporary disability benefits.
Misrepresenting the severity of a claimed injury.
Employer Fraud
Occurs when an employer knowingly misrepresents facts about its employees in order to obtain a workers'
compensation coverage for a premium price that is less than what the employer would otherwise be obligated to pay
if all the facts about its employees were known to the issuer of the policy. Also occurs when an employer knowingly
misrepresents facts to avoid, deny or obtain compensation on behalf of employees, or knowingly lies about entitlement
to benefits to discourage an injured employee from pursuing a claim.
Examples of Employer Fraud
Under-reporting the number of employees
Misclassifying employees as independent contractors
Misrepresenting the nature of the work performed by the employee
Misrepresenting past loss experience
Misrepresenting the company ownership
Falsely informing an employee that workers' compensation benefits are only available if he or she has been
employed for six months or more.
Health Care Provider Fraud
Occurs when a health care provider knowingly and intentionally submits a material misrepresentation about medical
treatment afforded a workers' compensation claimant in a bill or invoice that the health care provider presents to the
Board or to the insurance carrier for payment. Health care fraud includes frauds committed by any provider in the
workers' compensation system, such as doctors, rehabilitation counselors, pharmacists, or chiropractors.
Examples of Health Care Provider Fraud
Billing for exams of patients who were never examined
Billing for treatment of patients who were never treated
Duplicate billing in order to receive payment from different insurance carriers for the same medical treatment
Billing follow-up exams as "first exams" to receive greater payment from the carrier
Bundling unnecessary medical services with necessary services
Misrepresenting the true code for the medical treatment provided
