Contract Risk and Compliance & Warranty Fraud. David Maberry Chief Risk Officer American Fidelity Assurance Company
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1 Contract Risk and Compliance & Warranty Fraud David Maberry Chief Risk Officer American Fidelity Assurance Company
2 Who am I and Why Am I Here? David Maberry is the Chief Risk Officer for American Fidelity Assurance in Oklahoma City, OK. He is responsible for developing and maintaining a comprehensive process for identifying, assessing, mitigating, monitoring, and reporting key operational, financial, strategic, technology and regulatory related risks that could potentially impact the organization s operations. Prior to coming to American Fidelity, David worked for 10 years as a Principal & Director in Deloitte and Touche s Audit and Enterprise Risk Services practice in Los Angeles. He served clients across multiple industries, including Healthcare, Financial Services, Technology, Consumer Business and Entertainment focusing on enterprise risk management, regulatory compliance, internal audit and information technology. David has presented at numerous events hosted by the Institute of Internal Auditors (IIA) and the Information Systems Audit and Control Association (ISACA). In addition, he is a frequent guest speaker at Texas A&M University, the University of Southern California and California State - Los Angeles on topics including enterprise risk management, internal control rationalization, and information technology risk. He is a graduate of Baylor University and the University of Wisconsin in Madison. 1
3 Class Objectives Why Contract Risk and Compliance Auditing? What are the Benefits? Extended Business Relationships What is the Process? Where is the Added Value? A Case Study: Warranty Fraud Questions 2
4 Why Contract Risk and Compliance Auditing? Simply put, Contract auditing is all about contractual obligations Everyone has business partners Everyone has contractual relationships Risk is inherent in every relationship/contract 3
5 What are the Benefits? CRC audits help maximize value and better evaluate risks in business relationships. Identify and mitigating risks associated with extended business relationships Ascertain whether the business is efficiently and properly reporting under contracts Help management understanding business partners controls and compliance with monetary and non-monetary aspects of their contracts with our company (including recovering excess costs and lost revenue) Includes understanding of end-to-end processes, not just monitoring of performance 4
6 Extended Business Relationships Supply-Side Partners Demand-Side Partners Licensees Infrastructure Suppliers Manufacturers Replicators Franchisees Distributors Resellers Original equipment manufacturers (OEMs) IT outsourcing HR services Travel agencies Integrators and installers Advertising agencies Retailers Co-brand partners Joint developers Legal services Benefit providers Fulfillment providers IP licensees Transaction processing Warranty, maintenance and repair providers 5
7 What is the Process? 6
8 Where is the Added Value? Corporate Governance Improve the quality information that is currently monitored and fulfill enterprise risk management responsibilities Stronger need to protect tangible and intangible assets Revenue Recoveries Identify instances of intentional and unintentional program abuse due to data reporting errors, system limitations, poor inventory management, and manipulation of incentives and special pricing programs Enhance Relationship Integrity, Improve Reporting Accuracy Information offers leverage in relationships and in negotiations Optimize partner and program performance 7
9 Where is the Added Value? Improved Partner Relationships Enhanced communications with business partners Clearer business objectives and expectations Customer / Partner Feedback Compliance inspections are a feedback mechanism Help strengthen agreements and contract management processes Control Evaluations Provides assurance that controls at business partners are operating as designed, including controls related to SOX compliance. Global Coverage Offshore and global operations are not exempt from compliance risks 8
10 A Case Study: Warranty Fraud
11 How long has THAT been there? 10
12 Examples: Warranty Fraud is Real The elephant has been in the room for a long time March 2005 Hewlett-Packard s warranty process manager announces at the Warranty Chain Management Conference that 6% to 8% of HP s warranty claims are fraudulent February 2007 The FBI issues an arrest warrant for a man accused of defrauding Medicare (the US medical system) in excess of $400,000 in fraudulent claims / 1975 General Motors cooperates in an investigation of Chevrolet dealers in the New York area for fraud through inflated warranty claims March 2006 Nokia cancels its reseller agreement with BlueTel. This company has claimed costs for repairs that have not been undertaken March 2007 The FBI announces the arrest of Cisco subcontractor, accused of having created fake warranty claims in excess of 10 million dollars 11
13 Defining the Iceberg Direct Costs Indirect Costs Forgone Earnings Parts Availability Management Satisfaction Unfair Competition Partner Satisfaction Brand Image Customer Satisfaction 12
14 Sources of Warranty Non-Compliance Partner warranty fraud There are several sources of non-compliant warranty claims. While they may be the result of flaws in the systems or processes, the costliest type of non-compliance for manufacturers typically result from the extended enterprise of partners and contractors. Example of fraud schemes Bias of statistics / generation of fake activity Abuse of entitlement Use of uncertified technicians Unauthorized activity Inflation of Services Obtaining of undue payments Parts theft Abuse of a DOA process 13
15 Building a Compliance Audit Program Please check in the below list the categories of technology that you use to either detect or investigate fraud: 1. Standard office tools: Microsoft Excel / Access 2. Fraud Dashboards: reports of historical transaction data with fraud controls or metrics 3. Script-based investigative analysis software: software which uses scripts, queries or commands to analyze data 4. Visual investigation software: software which provides visual representations of the data or of links within the data 5. Statistical analysis software: software which enable statistical analysis of the data 6. Other 14
16 Warranty Compliance Audit Objectives Program Objectives Prevention Case Management Detection and more! 15
17 Contract Management Framework Post Mortem Control Rationalization Awareness Risk Analysis Prevention Training Control implementation Financial Recovery Negotiation or Litigation Case Management Business Decision Investigation Financial Evaluation Detection Fraud Audits On-site Investigation Lead Generation Data Cleansing Data Analytics 16
18 Preventive Steps Identification of flaws and Process Improvements - Review the business processes and corresponding information systems in order to identify the potential risks and control weaknesses. Design and implement controls and/or modify quality procedures. Training / Sensitizing Teams - Train your teams to recognize fraud or non-compliance and sensitize them to the risks relevant to specific industry or channels. Create a methodology to support your anti-fraud team (e.g. How to react when a fraud is detected? How to conduct a fraud audit?...) and train team members on the different investigation tools that are available. Deterrence / Sensitizing the Partner Network - Hold workshops or conferences with your partners to sensitize them to the risk of fraud, and help communicate anti-fraud initiatives to your service network. Perform operational reviews of third-party providers. Creation of an Ethics Charter - Write an internal ethics charter and train teams on the importance of complying with this charter. Review and Optimization of Contractual Documents - Through a review of the contractual agreements with partners, identify the points of improvement (eg: audit clauses, penalties in case of fraud, conditions of de-accreditation ) 17
19 Detective Steps Creation of an Anti-fraud Team - Build and evaluate a business case for creating a Warranty Compliance Team (Compliance Team, Special Investigation Unit). Specify the scope and competency requirements for the team members and define navigation paths within the business organization. Definition of the Tools - Identify the data sources required to monitor service providers. Identify, implement and configure data investigation software to meet your detection and investigation needs. Design and Implementation of Detection Mechanisms - Design and implement the key detection indicators and define the on-line or off-line detection mechanisms. (eg: to analyze a specific delivery method) Identification of the Main Fraud Schemes - Through an analysis of specific business processes, systems and contracts, identify the risks to the organization and document the possible fraud schemes. Identification of Fraud Cases - Through a data analysis, identify the partners exhibiting suspicious behavior, and prioritize the cases to investigate. Monitor the channels that may be used to re-sell stolen products or parts (eg: ebay) Create a Case Management Strategy 18
20 And more! Warranty Compliance encompasses more than just Warranty Fraud. Several aspects of your Partner Program may influence the behavior of your partner network. Compensation model Design and/or review your payment scheme (how much money do the partners get to repair a machine?). Based on your needs, run simulations to determine the impact of a new payment strategy and manage the changes (system modification, partner communication, analysis of behaviors ) Accreditation process - Design or review your accreditation process (are the necessary verifications performed before authorizing a new partner?). If necessary, conduct audits to check that requirements are still met by the partners or if those partners indeed exist and/or have a good reputation. Audit strategy - Design and/or review your Audit Strategy. For example, define which partners should be targeted for an audit, improve your audit methodology, perform operational audits (quality, customer satisfaction, environmental risk ) Operational Risk - Analyze the risks associated to your organization model and/or systems (partner account management strategy, reporting of information via your systems, logistics/reverse logistics ) 19
21 Contact Information David Maberry Tel: David.maberry@af-group.com 20
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