The medical scheme industry in South Africa is competitive in relation to international standards. The medical scheme sector, as part of the healthcare industry, is negatively affected by the high rate of fraud perpetrated by providers, members and syndicates, which results in medical schemes funding fraudulent claims. The purpose of the study was to explore strategies to mitigate fraud in medical scheme claims. A qualitative research methodology was followed in this study, which adopted a case study approach. Empirical data was analysed through thematic analysis, with the aid of ATLAS.ti software. The study found that healthcare service providers mainly defraud medical schemes by submitting false claims. A holistic approach should be followed to mitigate fraud in medical scheme claims. This approach should encompass regularly identifying trends in fraudulent claims and implementing appropriate control strategies. Collaboration within the medical scheme industry and with other stakeholders would also help to elevate the fight against medical scheme fraud to a new level. Implementing the recommendations from the study will assist medical schemes to reduce the funds expended on fraudulent claims, thereby improving their financial viability and decreasing the rate of increase in medical scheme contributions for members. / Business Management / M. Com. (Business Management)

The use of credit cards has become a way of life in many parts of the world. Credit cards have also created many new opportunities for criminal activity. It is in this light that organizations such as VISA International have explored a variety of security alternatives by constantly reviewing security measures that may be applied to cards and devote considerable resources to the maintenance of security systems and programmes. These programmes mandated by the association, include uniform card standards, security standards for manufactures, embossing and encoding of cards, standards for mailing the cards and credit background investigations of applicants. These standards assist investigators in examining counterfeit cards and distinguish a counterfeit card from a genuine card. The constant reviewing of security features and methods by the association is to create a card that is technically difficult to alter or counterfeit. / Criminology and Security Science / M.Tech. (Forensic Investigation)

This research looks at the best practices applied by forensic investigators in conducting lifestyle audits on white collar crime suspects. The researcher explored, firstly, how a lifestyle audit relates to white collar crime investigations; secondly, the best practices in performing lifestyle audits on white collar crime suspects, and lastly, the various sources of information available to forensic investigators when conducting a lifestyle audit of a white collar crime suspect. As lifestyle audits will serve as an investigative tool in future forensic investigations into white collar crime, this study’s aim was to understand and create an awareness of the current best practices applied by forensic investigators within private sector forensic investigation practices while conducting lifestyle audits during white collar crime investigations. It also makes available research data regarding the concept of lifestyle audits in white collar crime investigations, the implementation of these audits, the benefits, and the best practices of these audits. The general purpose of this study was to provide practical recommendations on the best practices for lifestyle audits for forensic investigators within private sector. / Criminology / M. Tech. (Forensic Investigation)

This study investigates the question of investigative capacity of South African Police Service general detectives at the local station level with regard to fraud investigation. The research presented in this thesis is based on a qualitative thematic analysis of the systemic investigative capacity of the detectives handling fraud and related offences. Fraud related crimes are consistently dismissed and perceived as less serious than violent crime, yet the impact of fraud affects individuals, organisations, and society. This study includes interviews with n = 15 (83%) participants out of 18 (100%) using a semi-structured interview schedule for data collection. The available literature indicates the increasing incidents of general fraud being inadequately investigated at the local police stations because of investigative incapacity. The complexities of any criminal investigation require sufficient resources to achieve the highest level of investigative performance. In this regard, criminals are gradually outwitting the conventional methods of fraud investigation, especially in terms of technological advancements. The study’s findings reveal how general detectives are systematically tested to their capacity in relation to fraud investigation – inter alia, participants identified the following challenges to meeting investigative objectives: ambiguous general fraud investigation directives, poor training, limited resources, abuse of available resources, unreasonably high workloads, and human resource shortages. These institutional factors need consideration to allow progress in criminal investigation procedures. This study creates the context for the recommendation that a series of systemic reforms be introduced, based on a professional model, pertaining specifically to fraud investigation at the local police station level. This means some of the distinct investigative practices that are effective be inverted and strengthened in recognition of the scope and complexity of general fraud, and the influence this complexity has on investigative methodology. For example, setting up proper and recognised station-level fraud units to handle incoming “general fraud” cases, staffed with trained detectives, who have access to adequate resources. This would create an opportunity to address institutional issues around training to rectify general detectives’ core skill deficiencies prior to them being assigned to criminal cases. Training should include case management, investigative procedures, and the use of technology (to effectively combat digital fraud). Moreover, it is vital to maintain an oversight over the fraud mandates which differentiate the scope of practice between vii specialist and general detectives, with a thorough understanding of what constitutes general fraud and complex, organised fraud. It is furthermore suggested that local and international best practice trends be implemented by general detectives in their fraud investigations. / Thutopatlisiso eno e sekaseka ntlha ya bokgoni jwa go batlisisa jwa matseka a kakaretso a Tirelo ya Sepodisi sa Aforikaborwa kwa legatong la seteišene sa selegae malebana le dipatlisiso tsa boferefere. Patlisiso e e tlhagisitsweng mo thesising eno e theilwe mo tshekatshekong e e supang, e tlhatlhoba le go kwala ditiragalo tsa bokgoni jwa go dira dipatlisiso jwa matseka a a dirang ka ditlolomolao tsa boferefere le tse di amanang le tseo. Bosenyi jo bo amanang le boferefere gantsi bo kgaphelwa thoko mme bo tsewa e le bosenyi jo bo sa tsenelelang go tshwana le bosenyi jwa tirisodikgoka, fela ditlamorago tsa boferefere di ama batho, ditheo le setšhaba. Thutopatlisiso eno e akaretsa dipotsolotso le banni le seabe ba le n = 15 (83%) go tswa go ba le 18 (100%), go dirisiwa sejule ya dipotsolotso e e batlileng e rulagane go kokoanya tshedimosetso. Dikwalo tse di gona di supa koketsego ya ditiragalo tsa go se batlisisiwe go go lekaneng ga boferefere jwa kakaretso kwa diteišeneng tsa selegae tsa sepodisi ka ntlha ya tlhaelo ya bokgoni jwa go batlisisa. Marara a patlisiso epe fela ya bosenyi a tlhoka ditlamelo tse di lekaneng go fitlhelela tiragatso e e kwa godimo ya patlisiso. Mo ntlheng eno, disenyi di tlhalefetse mekgwa ya tlwaelo ya dipatlisiso tsa boferefere, bogolo segolo mo ntlheng ya tswelelopele ya thekenoloji. Diphitlhelelo tsa thutopatlisiso di bontsha ka moo bokgoni jwa matseka bo lebaganang le teko e e boitshegang ka gona malebana le dipatlisiso tsa boferefere – gareng ga tse dingwe, banni le seabe ba supile dikgwetlho tse di latelang malebana le go fitlhelela maitlhomo a dipatlisiso: dikaelo tse di sa tlhamalalang ka kakaretso malebana le dipatlisiso tsa boferefere, katiso e e bokoa, ditlamelo tse di tlhaelang, tiriso e e botlhaswa ya ditlamelo tse di gona, selekano sa tiro se se kwa godimo moo go sa amogelesegeng mmogo le tlhaelo ya badiri. Dintlha tseno tsa mo setheong di tlhoka go lebelelwa go kgontsha gore go nne le tswelelopele mo ditsamaisong tsa dipatlisiso tsa bosenyi. Thutopatlisiso eno e tlhoma bokao jwa dikatlenegiso tsa gore go itsesewe diphetogo tsa thulaganyo di le mmalwa, di theilwe mo sekaong sa porofešenale, se se totileng dipatlisiso tsa boferefere kwa legatong la seteišene sa selegae sa sepodisi. viii Seno se kaya gore ditiragatso dingwe tsa dipatlisiso tse di dirang sentle di rulaganngwe sešwa le go maatlafadiwa go lebeletswe bogolo le marara a boferefere ka kakaretso, mmogo le tshusumetso ya marara ano mo mokgweng wa dipatlisiso. Seno se kaya, go naya sekai, go tlhoma diyuniti tsa boferefere tse di siameng le tse di lemogwang kwa legatong la seteišene go samagana le dikgetse tse di tsenang tsa "boferefere jwa kakaretso", di na le matseka a a katisitsweng, a a kgonang go fitlhelela ditlamelo tse di maleba. Seno se tlaa dira tšhono ya go samagana le dintlha tsa setheo malebana le katiso go lolamisa tlhaelo ya bokgoni jwa botlhokwa jwa matseka a kakaretso pele ga ba ka rebolelwa dikgetse tsa bosenyi. Katiso e tshwanetse go akaretsa tsamaiso ya dikgetse, tsamaiso ya dipatlisiso le tiriso ya thekenoloji (go lwantsha boferefere jwa dijitale ka nonofo). Mo godimo ga moo, go botlhokwa go nna le tlhokomelo ya dithomo tsa boferefere e e farologanyang tiro ya matseka a baitseanape le a kakaretso, go tlhaloganngwa sentle pharologano magareng ga boferefere jwa kakaretso le boferefere jo bo marara jo bo rulaganeng. Gape go tshitshinngwa gore matseka a kakaretso a diragatse mekgwa ya tiragatso e e gaisang ya selegae le ya boditšhabatšhaba mo dipatlisisong tsa ona tsa boferefere. / Police Practice / D. Litt. et Phil. (Police Science)

Zugl.: Augsburg, Universiẗat, Diss., 2005.

Financial fraud rampages onwards seemingly uncontained. The annual cost of fraud in the UK is estimated to be as high as £193bn a year [1] . From a data science perspective and hitherto less explored this thesis demonstrates how the use of linguistic features to drive data mining algorithms can aid in unravelling fraud. To this end, the spotlight is turned on Financial Statement Fraud (FSF), known to be the costliest type of fraud [2]. A new corpus of 6.3 million words is composed of102 annual reports/10-K (narrative sections) from firms formally indicted for FSF juxtaposed with 306 non-fraud firms of similar size and industrial grouping. Differently from other similar studies, this thesis uniquely takes a wide angled view and extracts a range of features of different categories from the corpus. These linguistic correlates of deception are uncovered using a variety of techniques and tools. Corpus linguistics methodology is applied to extract keywords and to examine linguistic structure. N-grams are extracted to draw out collocations. Readability measurement in financial text is advanced through the extraction of new indices that probe the text at a deeper level. Cognitive and perceptual processes are also picked out. Tone, intention and liquidity are gauged using customised word lists. Linguistic ratios are derived from grammatical constructs and word categories. An attempt is also made to determine ‘what’ was said as opposed to ‘how’. Further a new module is developed to condense synonyms into concepts. Lastly frequency counts from keywords unearthed from a previous content analysis study on financial narrative are also used. These features are then used to drive machine learning based classification and clustering algorithms to determine if they aid in discriminating a fraud from a non-fraud firm. The results derived from the battery of models built typically exceed classification accuracy of 70%. The above process is amalgamated into a framework. The process outlined, driven by empirical data demonstrates in a practical way how linguistic analysis could aid in fraud detection and also constitutes a unique contribution made to deception detection studies.

This thesis focuses on fraud in the entity, to methods for their detection and possibilities of improving the internal control system so that the risk of offending employee or manager has been reduced to a minimum.

The aim of the thesis is to evaluate the possibilities of evaluation of the risk of accounting frauds and accounting mistakes in the financial statements compiled in terms of Czech accounting standards for their users using analytical tools and methods of the financial analysis. Part of the thesis is the proposal of concrete tools or models that reduce the asymmetry of information between the makers of the financial statements and other users of the financial statements and can be implemented in the internal control system of the unit when decision-making on the financial health of selected accounting units. For practical part was chosen an enterprise with a long tradition. Monitoring ratios of The Beneish Model M-Score detect risk areas and tracking ratio trend may alert management to instability in the financial statement. Liquidity and debt ratios are also appropriate methods for reducing the information asymmetry.

This research looks at the best practices applied by forensic investigators in conducting lifestyle audits on white collar crime suspects. The researcher explored, firstly, how a lifestyle audit relates to white collar crime investigations; secondly, the best practices in performing lifestyle audits on white collar crime suspects, and lastly, the various sources of information available to forensic investigators when conducting a lifestyle audit of a white collar crime suspect. As lifestyle audits will serve as an investigative tool in future forensic investigations into white collar crime, this study’s aim was to understand and create an awareness of the current best practices applied by forensic investigators within private sector forensic investigation practices while conducting lifestyle audits during white collar crime investigations. It also makes available research data regarding the concept of lifestyle audits in white collar crime investigations, the implementation of these audits, the benefits, and the best practices of these audits. The general purpose of this study was to provide practical recommendations on the best practices for lifestyle audits for forensic investigators within private sector. / Criminology and Security Science / M. Tech. (Forensic Investigation)

The primary goal of this study is firstly to analyse the Fraud Prevention Policy and Strategy, the Policy on Protection of Whistle-Blowers, and the Policy Document on Forensic Audit Process of the Department of Trade and Industry (DTI) in order to establish the reason for the ongoing spate of fraudulent and corrupt activities among employees within the DTI Head Office, regardless of the relevant policies put in place. Secondly, another goal is also to establish other reasons that could be linked to the reoccurrence of fraudulent and corrupt activities within the DTI. During the research survey questionnaires were administered to employees of the DTI. Furthermore, online interviews were conducted with a purposively selected sample within two divisions of the DTI. In addition, a literature study was conducted to acquire relevant information and perspectives from available national and international literature. Various objectives were fulfilled in this study as follows:  It was established whether the reporting of internal or external fraud and corruption and the relevant policies put in place contribute in any manner to the prevention of fraudulent and corrupt activities at the Department of Trade and Industry's national office.  It was determined if there is a policy document on measuring these policies after they have been implemented.  It was determined how the Department of Trade and Industry's national head office addresses fraud and corruption. Other possible reasons for the Department of Trade and Industry employees' lack of reporting fraud and corruption in their departments, other than the fear of being victimised, were identified.  The views and opinions on the internal reporting of fraud and corruption were determined.  The degree of awareness of the investigative procedures related to fraud and corruption among the Department of Trade and Industry management and their employees were determined.  It was established if employees have faith in the Department of Trade and Industry's investigative procedures to fraud and corruption.  The extent of knowledge on the importance of reporting fraudulent and corrupt activities in the DTI were established.  Feedback to help minimise fraud and corruption within the Department of Trade and Industry and improve future strategies was provided. This study contributes to the knowledge base with regard to fraud and corruption within the Department of Trade and Industry. / Criminology and Security Science / M. Tech (Policing)