how do they know what the payment is for?

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people most probably trade on KYC exchanges like binance and okx, (i know it's awful) there are only 3 options for the payment, bank transfer, WeChat Pay and Alipay, all with in fiat.

I think I missed your question.

*they* monitor individual tractions in real time. once a whale selling Bitcoin get a big influx in their account, they simply suspend the flow for the "security" reasons.