Question: Fraud is an ongoing problem and is a tremendous cost for many organizations and their operations. According to the Federal Bureau of Investigation (FBI), non-healthcare-related

Fraud is an ongoing problem and is a tremendous cost for many organizations and their operations. According to the Federal Bureau of Investigation (FBI), non-healthcare-related fraud alone is estimated to cost the U.S. over $40 billion a year (Crews, 2015)! With that piece of information, could you imagine those other areas that are healthcare-related? Certain factors must be presented to allow most individuals to commit these crimes, therefore, fraud and other unethical behavior do not just happen randomly (Crew, 2015). American criminologist Donald Cressey developed a theory known as the Fraud Triangle that introduces the root causing elements: pressure, opportunity, and rationalization that lead to fraud and other unethical behavior (Crew, 2015). When businesses and organizations start to understand the Fraud Triangle, they can more effectively combat criminal behavior that negatively impacts their operations (Crew, 2015). The fraud triangle provides a useful framework for organizations to analyze their vulnerability to fraud and unethical behavior (Crew, 2015), Cresseys hypothesis was, Trusted persons become trust violators when they conceive of themselves as having a financial problem which is non-sharable, are aware this problem can be secretly resolved by violation of the position of financial trust, and are able to apply to their own conduct in that situation verbalizations which enable them to adjust their conception of themselves as trusted persons with their conceptions of themselves as users of the entrusted funds or property (ACFE, 2022)

Compared to the Cresseys Fraud Triangle theory, the Fraud Diamond, a newer theory proposed by David T. Wolfe and Dana Hermanson, asserts that the fraudsters capability; the forth element must also be taken into account (ACFE, 2022). The fraudster, it is said, must have the required traits (e.g., greed, weakness of character, excessive pride, dishonesty, etc.) and abilities (e.g., knowledge of processes and controls) to actually commit the fraud. It can be argued, however, that the traits are components of pressure and that abilities are opportunity factors *ACFE, 2022). In the process the Fraud Diamond theory 10-80-10 Rule that supports its general assumption by breaking down the population and likelihood of fraud occurrences (ACFE, 2022). Essentially states that:

  • 10 percent of the population will NEVER commit fraud. This is the type of person that will go out of their way to return items to the correct party.
  • 80 percent of the population might commit fraud given the right combination of opportunity, pressure, and rationalization.
  • 10 percent of the population are actively looking at systems and trying to find a way to commit fraud.

*Source: National Association of State Auditors, Comptrollers and Treasurers (NASACT) and the Oregon State Controllers Division (ACFE, 2022).

Fraud is essentially a premeditated act, and it takes a thought process, and the very elements of both theories that overlap their thought process, motivators and personality that lead them to commit the unethical act. Moreover, The Dark triad ethical decision-making model further evaluates the dark triad of personality traits (i.e., psychopathy, Machiavellianism, and narcissism) on fraud intentions and behaviors (Harrison et al., 2018).

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