The purpose of this study was to examine how cheating during exams threatens the legitimacy of university degrees awarded by privately-owned institutions in Ghana. The study also examined why many students cheat on exams, what happens to them after they are caught, and what can be done to prevent cheating from occurring. There have been numerous calls for action to reduce cheating at the University level in Sub-Saharan Africa. However, there continues to be a significant lack of understanding regarding the extent of cheating at the University level. This report used a systematic literature review methodology. A total of 96 studies were reviewed. These studies spanned the period from 2012 to 2023. As well, the authors of the current report conducted over ten years of empirical research into the topic of academic integrity within higher education in Ghana. The report will explore several different areas. First, an overview of the theoretical underpinnings of cheating will be discussed. Data collected empirically on the frequency and kinds of cheating behaviours experienced by students at privately owned universities in Ghana will follow this report. Afterwards, a variety of causes of cheating behaviour will be examined. The causes identified in this study included societal pressures to obtain a university degree for job prospects or social status; inadequate supervision; various forms of technology that make it easier for students to cheat; and several institutional vulnerabilities. In addition to examining the causes of cheating behaviours, this study will identify and explore the effects of such behaviours. Identified effects of cheating behaviours include severe academic penalties (e.g., cancellation of exam results; suspension or expulsion); psychological harm (e.g., anxiety, shame, stigma); potential career jeopardy (e.g., damaged job prospects; certification/ licensure barriers); and reputational harm to the institution (e.g., loss of reputation with accrediting agencies; loss of public trust). Additionally, some factors that may contribute to higher rates of cheating among students enrolled in private universities compared to those enrolled in state-owned universities will be highlighted. Factors cited in this regard included increased economic pressure experienced by students due to high tuition costs; the competitive nature of private universities; less stringent supervisory oversight; and an overall system-wide lack of accountability regarding the admission process.