Purpose: Academic integrity is vital to the success and sustainability of the academic project and particularly critical in the training of ethical and informed health professionals. Yet studies have found that cheating in online exams was commonplace during the COVID-19 pandemic. With the increased use of online and blended learning post-COVID-19, an understanding of student cheating dynamics is essential for developing effective strategies to combat academic dishonesty in the rapidly changing educational landscape. Design/methodology/approach: This study explored academic integrity and reasons for dishonesty from the perspective of health sciences students at a South African University of Technology (UOT) via the Fraud Diamond. To gain an in-depth understanding of the topic, a qualitative method was employed, and data were collected via focus group discussions with nine student class representatives. These data were analysed thematically using the Clarke and Braun approach. Findings: Cheating during online assessment was common and innovative, with students manipulating others and exploiting friendships to facilitate dishonest practices. Student motivations for dishonesty included a lack of consequences and pressure due to a lack of time management, engagement and preparation. Practical implications: This study underscores the need for institutions to adopt an adaptable, multi-faceted approach that addresses student cheating opportunity, motivation and normalisation of dishonest practices whilst strengthening academic integrity policies and enforcement thereof. Originality/value: The findings contribute valuable insights into the ongoing academic integrity crisis in higher education in the South African context.