They track the IP addresses of the browser clients that are fetching the ads, so it would be easy to see that you are showing each viewer 10 ads when it should only be 1.
If you steal enough to be worth it, your viewing stats will be abnormal enough to stand out to their automated fraud tools.
Some sample automated checks:
* How many ads per unique IP address
* Average time between ads for IP address
* Min and Max time between ads for IP address
* Ads relative to number of visitors to the site, compared against similar sites
If you stand out, it trips alarms for deeper investigation.
They might also have automated tools to scan the pages server by your site for script code that abuses the ad serving.
If there are know "abuse toolkits" out there then an ad network might have also code to detect them, similar to detecting a virus.