ACFE CFE - Law (Certified Fraud Examiner - Law) Practice Test 19

Question 180

An organization retains copied passports indefinitely with no documented necessity. What legal issue arises apart from identity theft?

  1. Personal-data retention compliance
  2. Identity-document trafficking
  3. Identity-based application fraud
  4. Account takeover

Explanation

Correct Answer

A:

Privacy regimes can restrict collection and retention of personal identity data to lawful, necessary purposes and defined periods.

Incorrect Answers

B:

Document and identity offenses may penalize knowing transfers or misuse of identification means in relation to unlawful activity; personal-data retention compliance addresses the distinct legal requirement stated in the facts.

C:

Using stolen identifying information in an application combines deception of the lender with unlawful use of the victim's identity; personal-data retention compliance raises a different threshold from this alternative.

D:

Unauthorized appropriation of an existing account through compromised identity or authentication information can support identity and computer-related offenses; that concept must be distinguished from Personal-data retention compliance here.

Question 181

A policyholder deliberately invents a nonexistent theft to obtain an insurance payment. Which fraud form is illustrated?

  1. Inflated loss adjustment
  2. Material nondisclosure in underwriting
  3. Insurance premium diversion
  4. Fabricated insurance claim

Explanation

Correct Answer

D:

Insurance fraud commonly involves intentional material falsehoods to obtain benefits not owed, with offenses defined by the governing statute.

Incorrect Answers

A:

False descriptions of actual repair work or loss amounts can support a claim-payment fraud theory against the payer; fabricated insurance claim is the issue raised by the described conduct.

B:

Misrepresentation or failure to disclose relevant risk may permit specified remedies where the legal disclosure duty and other conditions exist; the inquiry instead concerns Fabricated insurance claim, with its own elements.

C:

An intermediary who misappropriates premiums may face fiduciary, theft, regulatory and civil liability depending on entrustment; the relevant step in this scenario is Fabricated insurance claim.

Question 182

An applicant intentionally hides a material prior loss when procuring insurance. Which insurance-law concern arises?

  1. Inflated loss adjustment
  2. Fabricated insurance claim
  3. Material nondisclosure in underwriting
  4. Insurance premium diversion

Explanation

Correct Answer

C:

Misrepresentation or failure to disclose relevant risk may permit specified remedies where the legal disclosure duty and other conditions exist.

Incorrect Answers

A:

False descriptions of actual repair work or loss amounts can support a claim-payment fraud theory against the payer; those prerequisites should not be confused with Material nondisclosure in underwriting.

B:

Insurance fraud commonly involves intentional material falsehoods to obtain benefits not owed, with offenses defined by the governing statute; material nondisclosure in underwriting addresses the distinct legal requirement stated in the facts.

D:

An intermediary who misappropriates premiums may face fiduciary, theft, regulatory and civil liability depending on entrustment; material nondisclosure in underwriting raises a different threshold from this alternative.

Question 183

An agent diverts client premiums to a personal account instead of forwarding them to an insurer. Which wrongdoing is implicated?

  1. Insurance premium diversion
  2. Inflated loss adjustment
  3. Fabricated insurance claim
  4. Material nondisclosure in underwriting

Explanation

Correct Answer

A:

An intermediary who misappropriates premiums may face fiduciary, theft, regulatory and civil liability depending on entrustment.

Incorrect Answers

B:

False descriptions of actual repair work or loss amounts can support a claim-payment fraud theory against the payer; the circumstances point to Insurance premium diversion rather than that separate test.

C:

Insurance fraud commonly involves intentional material falsehoods to obtain benefits not owed, with offenses defined by the governing statute; insurance premium diversion is the issue raised by the described conduct.

D:

Misrepresentation or failure to disclose relevant risk may permit specified remedies where the legal disclosure duty and other conditions exist; the inquiry instead concerns Insurance premium diversion, with its own elements.

Question 184

A repair provider bills an insurer for replacement parts that were never installed. Which fraud mechanism is involved?

  1. Material nondisclosure in underwriting
  2. Inflated loss adjustment
  3. Fabricated insurance claim
  4. Insurance premium diversion

Explanation

Correct Answer

B:

False descriptions of actual repair work or loss amounts can support a claim-payment fraud theory against the payer.

Incorrect Answers

A:

Misrepresentation or failure to disclose relevant risk may permit specified remedies where the legal disclosure duty and other conditions exist; here the operative distinction is Inflated loss adjustment.

C:

Insurance fraud commonly involves intentional material falsehoods to obtain benefits not owed, with offenses defined by the governing statute; those prerequisites should not be confused with Inflated loss adjustment.

D:

An intermediary who misappropriates premiums may face fiduciary, theft, regulatory and civil liability depending on entrustment; inflated loss adjustment addresses the distinct legal requirement stated in the facts.

Question 185

A clinic bills a public health insurer for patients who were never examined. Which offense-related concept is implicated?

  1. Physician self-referral restriction
  2. Health-care upcoding fraud
  3. Health-care anti-kickback violation
  4. False health-care billing

Explanation

Correct Answer

D:

Knowingly billing for services not provided can violate health-care payment fraud and false-claim laws when their elements are met.

Incorrect Answers

A:

Certain self-referral laws restrict designated services furnished through specified financial relationships, independent of overt bribery proof; that concept must be distinguished from False health-care billing here.

B:

Knowingly representing a more lucrative level of care than actually supplied can constitute false billing under payment rules; the circumstances point to False health-care billing rather than that separate test.

C:

Specified referral remuneration can trigger anti-kickback restrictions, with exceptions and safe harbors requiring careful legal analysis; false health-care billing is the issue raised by the described conduct.

Question 186

A physician receives payments for referring beneficiaries to a supplier where a statutory prohibition applies. Which legal risk is central?

  1. Health-care upcoding fraud
  2. False health-care billing
  3. Physician self-referral restriction
  4. Health-care anti-kickback violation

Explanation

Correct Answer

D:

Specified referral remuneration can trigger anti-kickback restrictions, with exceptions and safe harbors requiring careful legal analysis.

Incorrect Answers

A:

Knowingly representing a more lucrative level of care than actually supplied can constitute false billing under payment rules; the relevant step in this scenario is Health-care anti-kickback violation.

B:

Knowingly billing for services not provided can violate health-care payment fraud and false-claim laws when their elements are met; here the operative distinction is Health-care anti-kickback violation.

C:

Certain self-referral laws restrict designated services furnished through specified financial relationships, independent of overt bribery proof; those prerequisites should not be confused with Health-care anti-kickback violation.

Question 187

A physician refers federally reimbursed patients to an entity with prohibited financial relationships. Which separate rule may be relevant?

  1. Health-care upcoding fraud
  2. False health-care billing
  3. Health-care anti-kickback violation
  4. Physician self-referral restriction

Explanation

Correct Answer

D:

Certain self-referral laws restrict designated services furnished through specified financial relationships, independent of overt bribery proof.

Incorrect Answers

A:

Knowingly representing a more lucrative level of care than actually supplied can constitute false billing under payment rules; physician self-referral restriction raises a different threshold from this alternative.

B:

Knowingly billing for services not provided can violate health-care payment fraud and false-claim laws when their elements are met; that concept must be distinguished from Physician self-referral restriction here.

C:

Specified referral remuneration can trigger anti-kickback restrictions, with exceptions and safe harbors requiring careful legal analysis; the circumstances point to Physician self-referral restriction rather than that separate test.

Question 188

A hospital intentionally alters diagnostic codes to secure greater insurer reimbursement. Which scheme is illustrated?

  1. False health-care billing
  2. Health-care anti-kickback violation
  3. Physician self-referral restriction
  4. Health-care upcoding fraud

Explanation

Correct Answer

D:

Knowingly representing a more lucrative level of care than actually supplied can constitute false billing under payment rules.

Incorrect Answers

A:

Knowingly billing for services not provided can violate health-care payment fraud and false-claim laws when their elements are met; the inquiry instead concerns Health-care upcoding fraud, with its own elements.

B:

Specified referral remuneration can trigger anti-kickback restrictions, with exceptions and safe harbors requiring careful legal analysis; the relevant step in this scenario is Health-care upcoding fraud.

C:

Certain self-referral laws restrict designated services furnished through specified financial relationships, independent of overt bribery proof; here the operative distinction is Health-care upcoding fraud.

Question 189

A hospital cyberattack has two phases with different legal characteristics. (1) Criminals distribute a convincing IT helpdesk message that directs employees to a fake sign-in portal and captures their credentials; which technique obtains access? (2) After entry, the criminals encrypt critical patient scheduling systems and demand money for a decryption key; which coercive cybercrime pattern is involved? Choose TWO.

  1. Deepfake-enabled impersonation
  2. Pharming and redirection fraud
  3. Phishing-based credential theft
  4. Ransomware extortion

Explanation

Correct Answers

C:

Deceptive electronic impersonation used to obtain private credentials can support fraud, identity and computer-access offenses; it specifically answers numbered situation 1.

D:

Malicious encryption paired with a payment demand may implicate computer damage, extortion and related financial crime provisions; it specifically answers numbered situation 2.

Incorrect Answers

A:

Synthetic media can supply the deception in an established fraud offense; the applicable law still requires its own intent and other elements; the separate questions call for phishing-based credential theft and ransomware extortion, while no prompt asks for this additional rule.

B:

Technical redirection toward fraudulent sites is distinct from merely emailing a deceptive link and may support computer and fraud claims; the separate questions call for phishing-based credential theft and ransomware extortion, while no prompt asks for this additional rule.

Question 190

Attackers both encrypt a company's servers and threaten to publish separately stolen client files unless paid. Which added exposure distinguishes this incident from a ransomware event limited to data unavailability?

  1. Initial phishing used to acquire access credentials
  2. An availability-only ransomware demand without stolen-file threats
  3. Double-extortion pressure from threatened disclosure of exfiltrated data
  4. Encryption as the only effect requiring an incident response

Explanation

Correct Answer

C:

Threatening release of stolen records adds confidentiality and notification risks to the availability harm caused by encryption; the offense and obligations depend on applicable law.

Incorrect Answers

A:

Credential theft may be the entry technique, but it does not describe the later two-pronged threat involving both encrypted operations and disclosure of exfiltrated data.

B:

Classic encryption ransom primarily pressures the victim through inaccessible systems; this case adds leverage from the adversary's threatened publication of separately taken information.

D:

Recovering encrypted servers addresses availability, but a threatened release of stolen files calls for an additional confidentiality, regulatory-notification and victim-harm assessment.

Certified Fraud Examiner - Law (CFE - Law) Practice Tests