Internal Code : MAS1496
Case Study -
You are a graduate accountant and have just landed your dream job with a forensic accounting firm in Hawthorn, Victoria. Your boss has asked you to travel to their US office to work with the team on a potential dental insurance fraud case, and gain valuable experience in investigative techniques. The company you are assisting processes dental insurance claims for insurance companies. The company receives the insurance claims from dental offices, achieves authorisation from the correct insurance company, and sends payment cheques. In your role you work with the insurance companies and dental offices - you do not deal with dental customers directly.
After two months with the company, you think a number of frauds may be occurring, and you feel the best way to search for these frauds is to investigate documentary evidence. Because hundreds of dental offices send insurance claims to your office, some may not be real dental offices. You contact the IT department and receive a set of files that represent the documents involved in transactions for the past three months.
1. As a forensic accountant, the first thing you should do with these files is calculate a checksum.
a. Explain thoroughly what a checksum is, and why this is the first thing you should do with these files.
b. Using the following online checksum calculator
https://defuse.ca/checksums.htm#checksums calculate the SHA-1 checksum for the following files:
c. Why might your checksums be different from other students in this class?
d. Explain what each of the files represents – what information is contained within.
2. Some dental offices may not employ real dentists and may be front companies that are sending claims out for work not performed. Are there any dental offices that you suspect may not be real? What makes you suspect this?
3. Sort the claims file by columns C & B. Are there any suspicious entries? Why?
4. Using the claims file, ascertain if any patients seem to be visiting their dentist too often? Which dentist and patients makes you most suspicious and explain why you are suspicious?
5. Are there any anomalies in patient addresses that make you suspicious of fraudulent activity?