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Published byMay Pope Modified over 8 years ago
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What is the purpose of your audit Suggest corrective measures Identify potential cost savers Determine compliance with company policy/regulations Criminal investigation/prosecution: Forensic
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Know the potential Crimes/violations Definition of fraud Intentional perversion of truth in order to induce another to part with something of value or to surrender a legal right b : an act of deceiving or misrepresenting : a misrepresentation or concealment of some fact material to a transaction that is made with knowledge of its falsity and with the intent to deceive another “The lie is the fraud and the fraud is the lie.”
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SAMPLE VIOLATION: Insurance Code Section 11880(a): Premium Fraud Elements of the crime A person makes or causes to be made any false statement Of a fact material to the determination of the premium, rate or cost of a workers’ compensation insurance policy administered by SCIF Knowing it is false For the purpose of reducing the premium, rate or cost of the insurance
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Know your victim’s business Workers’ Comp Insurance Background for IC 11880(a): knowing how rates/premiums are determined Rate determined by percentage of payroll paid by employer Number of employees x hourly wage paid = payroll For particular job classification Roofers are more expensive to insure than clerical due to higher risk of injury. Multiplied by the employer’s experience modification “X- mod” Employer’s past claims history: how safe is this employer “Good driver discount or bad driver penalty”
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Know your suspect’s business How could suspect cheat on his WC premium? Under-report number of employees Under-report their wages Misclassify their jobs to lower risk classification (Catch 22: some job classifications are based on the hourly rate paid: higher pay goes to more experienced workers = cheaper insurance rate BUT higher taxes so tell EDD rate of pay is lower) Conceal work related accidents/injuries
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What should you expect to find for documentation? What is employer legally required to file? Wage statements to SCIF Withholdings to EDD Accident reports to Cal OSHA Payroll records/time cards Work schedules Contracts with customers Permits from local government agencies
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What’s not there? The sins of omission Concealment may = fraud
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Who is in the best position to know the truth? The bookkeeper/accountant Employees Union reps Ex-employees Non-culpable partner/co-owner Witness with inside knowledge
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Where else could I find the evidence I’m looking for? Bank records Wage complaints filed with Dept Industrial Relations Company advertisements Social media Clients/Customers Permits issued/licenses granted
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Do the case like it was going to Jury Trial How can we PROVE what you believe to be the crime? Who can testify to necessary information Auditor as expert witness: beware cross-examination Explain case to jury: graphics, charts, layman’s terms Authentication of documents: Where did it come from How know it is accurate, who can authenticate How authenticate signatures Source documentation
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Trial (cont.) Write reports so layman can understand Permissible assumptions for tax purposes v. proof beyond a reasonable doubt for convictio Tax audit: burden on taxpayer to produce evidence of compliance Criminal prosecution: Burden of proof on prosecution
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Alternative charges Perjury at depositions Tax Fraud Forgery Grand Theft
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