Relevant bibliographies by topics / Investigation of insurance fraud

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Investigation of insurance fraud'

Author: Grafiati
Published: 4 June 2021
Last updated: 17 February 2022

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Journal articles on the topic "Investigation of insurance fraud"

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Boyer, M. Martin. "Centralizing Insurance Fraud Investigation*." Geneva Papers on Risk and Insurance Theory 25, no. 2 (December 2000): 159–78. http://dx.doi.org/10.1023/a:1008766413327.

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Tseng, Lu-Ming. "Customer insurance frauds: the influence of fraud type, moral intensity and fairness perception." Managerial Finance 45, no. 3 (March 11, 2019): 452–67. http://dx.doi.org/10.1108/mf-04-2018-0162.

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Purpose The purpose of this paper is to examine customers’ ethical attitudes (EA) and intentions toward two types of insurance frauds. This study proposes that the factors, such as fraud types (i.e. opportunistic and planned insurance fraud), moral intensity and fairness perception (FP), can affect the customers’ acceptance of the insurance frauds. Design/methodology/approach To test the research hypotheses of this study, Taiwanese insurance customers are invited in the empirical investigation, and a scenario-based questionnaire is used to collect the data. The hypotheses of this study are tested by using a partial least squares regression. Findings The results show that moral intensity constructs and FP significantly relate to the respondents’ acceptance of insurance frauds, while fraud types also have significant impacts on the respondents’ perceptions of moral intensity and fairness. Originality/value There is no research which has examined the relationships among fraud types, moral intensity, FP, demographic variables and customers’ EA and intentions toward insurance frauds. Understanding the relationships among these variables could provide implications for those involved in the practice of anti-fraud programs.
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von Bieberstein, Frauke, and Jörg Schiller. "Contract design and insurance fraud: an experimental investigation." Review of Managerial Science 12, no. 3 (February 10, 2017): 711–36. http://dx.doi.org/10.1007/s11846-017-0228-1.

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Majewski, Wojciech. "Integrated Platform for Identification and Verification of Insurance Crime as a Modern Tool to Combat Insurance Fraud – Legal Conditions." Prawo Asekuracyjne 4, no. 101 (December 15, 2019): 70–83. http://dx.doi.org/10.5604/01.3001.0013.6743.

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This article aims at outlining the role of the Insurance Guarantee Fund in preventing the phenomena related to insurance crime by means of the Integrated Platform for Identification and Verification of Insurance Crime.It also discusses the legal possibilities and limitations of sharing and exchanging data related to the operation of the anti-fraud platform. Being the only entity entitled to process motor insurance data centrally, the Fund plays a leading role in eliminating fraud in this field. At the same time, the article provides an analysis of legal issues related to the Fund's rights in the area of identification and verification of insurance fraud, and explores potential opportunities to improve the efficiency of insurance crime investigation resulting from the implementation of possible changes in law.
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Kim, Yongbum, and Miklos A. Vasarhelyi. "A Model to Detect Potentially Fraudulent/Abnormal Wires of an Insurance Company: An Unsupervised Rule-Based Approach." Journal of Emerging Technologies in Accounting 9, no. 1 (December 1, 2012): 95–110. http://dx.doi.org/10.2308/jeta-50411.

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ABSTRACT Fraud prevention/detection is an important function of internal control. Prior literature focused mainly on fraud committed by external parties, such as customers. However, according to a survey by the Association of Certified Fraud Examiners (ACFE 2009), it was noted that employees posed the greatest fraud threat. This study proposes profiling fraud using an unsupervised learning method. The fraud detection model is based on potential fraud/anomaly indicators in the wire transfer payment process of a major insurance company in the United States. Each indicator is assigned an arbitrary score based on its severity. Once an aggregate score is calculated, those wire transfer payments whose total scores are above a threshold will be suggested for investigation. Our contribution is to report what we have learned and to document our findings using fraud/anomaly indicators to detect potential fraud and/or errors on real data from a major insurance company.
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Pustika Sukma, Dara, Adi Sulistiyono, and Widodo Tresno Novianto. "Fraud in Healthcare Service." SHS Web of Conferences 54 (2018): 03015. http://dx.doi.org/10.1051/shsconf/20185403015.

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In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare service. This research was taken place in several hospitals in Central Java Indonesia using non-doctrinal or empirical method on stakeholders related to national health insurance. The result of research showed that the substance of the ratification of Health Minister’s Regulation Number 36 of 2015 about Fraud Prevention in National Health Insurance in National Social Insurance System becomes the government’s attempt in suppressing fraud in healthcare service. In its structure, healthcare service occurs due to the pressure of enacted costing system, limited supervision, and justification in committing fraud and the imbalance between health service system and burden among clinicians, service provider not giving adequate incentive, inadequate medical equipment supply, system inefficiency, less transparency in health facilities, and cultural factor. Those who are responsible for the attempt of eradicating fraud such as Health Ministry, Regency/City Health Service, Hospital’s Board of Directors, Hospital Supervision Agency and Council, Social Insurance Administration Organization, professional organization, and Social Insurance participants should walk in the cycle starting from building awareness, reporting, detecting, investigating, sanction imposing, to building awareness.
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Munavalli, Sahana, and Sanjeevakumar M. Hatture. "Fraud Detection in Healthcare System using Symbolic Data Analysis." International Journal of Innovative Technology and Exploring Engineering 10, no. 9 (July 30, 2021): 1–7. http://dx.doi.org/10.35940/ijitee.h9269.0710921.

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In the era of digitization the frauds are found in all categories of health insurance. It is finished next to deliberate trickiness or distortion for acquiring some pitiful advantage in the form of health expenditures. Bigdata analysis can be utilized to recognize fraud in large sets of insurance claim data. In light of a couple of cases that are known or suspected to be false, the anomaly detection technique computes the closeness of each record to be fake by investigating the previous insurance claims. The investigators would then be able to have a nearer examination for the cases that have been set apart by data mining programming. One of the issues is the abuse of the medical insurance systems. Manual detection of frauds in the healthcare industry is strenuous work. Fraud and Abuse in the Health care system have become a significant concern and that too inside health insurance organizations, from the most recent couple of years because of the expanding misfortunes in incomes, handling medical claims have become a debilitating manual assignment, which is done by a couple of clinical specialists who have the duty of endorsing, adjusting, or dismissing the appropriations mentioned inside a restricted period from their gathering. Standard data mining techniques at this point do not sufficiently address the intricacy of the world. In this way, utilizing Symbolic Data Analysis is another sort of data analysis that permits us to address the intricacy of the real world and to recognize misrepresentation in the dataset.
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Chung Woong. "Analysis on Workload of Insurance Fraud Investigation Team in the Police." Journal of Korean Public Police and Security Studies 12, no. 3 (November 2015): 143–65. http://dx.doi.org/10.25023/kapsa.12.3.201511.143.

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Salami, Suleiman, and Abass Wahab Olabamiji. "THE EFFECT OF FRAUD ON PROFITABILITY OF LISTED DEPOSIT MONEY BANKS IN NIGERIA." Malaysian Management Journal 25 (July 9, 2021): 169–90. http://dx.doi.org/10.32890/mmj2021.25.7.

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The increasing rate of fraud occurrence and poor profitability rate in the listed Deposit Money Banks (DMBs) in Nigeria calls for a research investigation. To unravel the likely connection between fraud and profitability, this study has examined the effect of fraud on the profitability of listed DMBs in Nigeria. To achieve this objective, the study adopted a correlational research design and utilised secondary data extracted from the Nigerian Deposit Insurance Commission (NDIC) and published financial statements of the DMBs. The study focused on 14 listed DMBs for a six-year period (2012-2017). Panel multiple regression technique was used to estimate the model of the study. The findings showed that fraud (proxied by actual loss from fraud and staff involvement in fraud) has a negative and significant effect on profitability (proxied by return on asset) of listed DMBs in Nigeria. In line with the findings, this study has recommended that listed DMBs should establish fraud detection mechanisms which will entail the setting up of an efficient, reliable and functioning fraud detection unit to monitor transactions that may be susceptible to fraud.
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Sooksripaisarnkit, Poomintr. "Marine insurance – collateral lies: when lies are not fraud." Maritime Business Review 2, no. 1 (March 15, 2017): 52–56. http://dx.doi.org/10.1108/mabr-09-2016-0020.

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Purpose The purpose of this study is to review the reasoning of the judgment of the United Kingdom Supreme Court in Versloot Dredging BV and another (Appellants) v. HDI Gerling Industrie Versichering AG and Others (Respondents) [2016] UKSC 45 in finding that there is no remedy or sanction for the use of fraudulent devices (so-called “collateral lies”) in insurance claims and to consider potential implications for underwriters. Design/methodology/approach The methodology is a typical case law analysis starting from case facts and the reasoning with short comments on legal implications. Findings Despite no sanction provided by law for the use of fraudulent devices, the room still opens for the underwriters to stipulate the consequence of using the fraudulent devices by the express term in the insurance contract. Research limitations/implications The main implication from the judgment is that underwriters are likely to incur more investigating costs for insurance claims. Originality/value This work raises awareness of the marine insurance industry (especially underwriters) as to the approach of the English law towards the use of fraudulent devices.
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Dissertations / Theses on the topic "Investigation of insurance fraud"

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Pražanová, Markéta. "Problematika pojistného podvodu v ČR." Master's thesis, Vysoká škola ekonomická v Praze, 2010. http://www.nusl.cz/ntk/nusl-75473.

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The insurance fraud is frequent type of criminality at the present time. The perpetrators of this crime cause heavy economic damages to insurance companies. Objective of the thesis called "The insurance fraud in the Czech Republic" is to evaluate the current state of the problem of insurance fraud in the Czech Republic from the perspective of insurance companies, law enforcement authorities and new legislation. As well to describe the way of detection and investigation, characterize the offender, analyze the most frequent cases, typical methods of committing insurance fraud and to evaluate the statistics and trends from previous years. In the thesis are explained the principles of detecting insurance fraud in insurance companies and the preventive measures. Part of the thesis is to identify weaknesses in the fight against the insurance fraud.
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Konopíková, Marie. "Pojistné podvody." Master's thesis, Vysoká škola ekonomická v Praze, 2014. http://www.nusl.cz/ntk/nusl-205812.

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This thesis is focused on theme of insurance´s fraud, primarily from the legal aspects. The thesis consist of legislative of insurance fraud according to the Criminal Code, also including a list of punishment. The following part dedicate to active insurers fight against cheats, their investigation and using more effective instruments and measures of their prevention. The thesis doesn´t forget statistical data and development in detection of insurance fraud in last 5 years. There is also the judicature of High Court and the examples of practise.
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Gažová, Iva. "Pojistné podvody." Master's thesis, Vysoké učení technické v Brně. Ústav soudního inženýrství, 2010. http://www.nusl.cz/ntk/nusl-232511.

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This diploma thesis deals with the problems of insurance fraud in our society. The thesis is divided into several relatively separate sections. The theoretical part describes a basic characteristic, classification and origins of insurance fraud and it deals with a general description of perpetrators of fraudulent actions. An analysis of fraudulent actions in life and non-life insurance is carried out in the theoretical part of the diploma thesis. This work characterises the importance and the mutual relationship between detection and investigation of fraudulent actions. It also highlights the facts which aid and abet insurance fraud. The aim of the practical part of the diploma thesis was to carry out an analysis of various insurance fraud cases in the realm of motor insurance according to the subject, object and the most frequent variants of fraudulent actions and consequently create a profile of the perpetrator of insurance fraud on the basis of the evaluation of the analysis. The practical case study of client’s expedient behaviour enables us to look on detection of the particular insurance fraud. The end of the diploma thesis deals with recommendations for the measures which should be taken to fight insurance fraud.
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Gill, Karen Ann. "Insurance fraud : causes, characteristics and prevention." Thesis, University of Leicester, 2014. http://hdl.handle.net/2381/29106.

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Although there is a growing volume of research on various kinds of fraud, relatively little has been written about insurance fraud. Even fewer studies have been undertaken on the prevention of insurance fraud. This study aims to fill this gap. It focuses not on large-scale corporate fraud but on individuals ‘fiddling’ their home, motor and travel policies. During the course of this study, the researcher surveyed the public and found that insurance fraud is commonplace, and committed by people of different classes— often unwittingly, and rarely with much regret. Insurance companies were surveyed, and data collected by interviews with insurance staff. It emerged that many insurers did not realise they had an insurance fraud problem, and those that did were either doing little to prevent it or were using ineffective methods. Insurance fraudsters are often given a great deal of help, often by officials who abuse the trust placed in them; insurers’ relationship with the police and with loss adjusters is not geared to stopping fraudsters, and insurance fraud is thus rendered easier. To illustrate this, and with the help of an insurance company, the researcher conducted a mock insurance fraud, and found it easy to commit. This study shows that insurance fraud is mostly an opportunistic crime. Within the study of crime prevention there is an approach which seeks to reduce the number of offences by curtailing the opportunities for crime. This is known as ‘situational crime prevention’, and is based on the ‘rational choice perspective’. Professor Ron Clarke, whose name is most closely associated with the approach, has called for more research to apply the principles and techniques of opportunity reduction to a range of crime types. This thesis represents an attempt to do this in relation to insurance fraud, and in so doing to stimulate ideas on how insurance fraud can be tackled effectively. In addition, it offers a new perspective on the situational approach and the techniques of opportunity reduction, plus a revised classification of these techniques. At the same time it offers a critique of the situational approach itself. The findings suggest that if fraud within the insurance industry is to be taken seriously then there are a range of structural concerns that need to be tackled, and that this moves beyond the scope of situational prevention.
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Aboutajdine, Reda. "Deterrence and learning effects in insurance fraud audits." Thesis, Institut polytechnique de Paris, 2019. http://www.theses.fr/2019IPPAX016.

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La fraude à l'assurance est une menace majeure pour les marchés assurantiels dont le traitement passe par la conception de politiques d’audit crédibles et ciblées. Cette thèse étudie les mécanismes de dissuasion et d’apprentissage dans l’audit de la fraude l’assurance, notamment quand des prestataires (garagistes, opticiens, etc.) jouent le rôle d'intermédiaires entre l'assureur et les assurés. Le premier chapitre est une étude empirique des effets dissuasifs de l’audit, fruit d’une collaboration avec IBM France et PRO BTP, dans le cadre du déploiement de la solution anti-fraude Solon. Cette analyse montre que les audits subis par un opticien ont pour effet de réduire sa fraude future. Plus spécifiquement, l’effet dissuasif est d’autant plus fort que la menace d’audit est crédible, soulignant l’importance de l’engagement dans la lutte contre la fraude. Les deuxième et troisième chapitres étudient un problème d’audit dynamique où l'information joue un rôle central. L’auditeur y interagit de façon répétée avec des prestataires non-stratèges et peut apprendre à propos de leur propension à frauder sur la base des résultats de l'audit. Le deuxième chapitre utilise un modèle à deux périodes pour mettre en évidence cet effet d’apprentissage, dont la conséquence est qu’il est optimal d’auditer plus intensément au début de la relation. Le troisième chapitre étend ce modèle à un nombre arbitraire ou infini de périodes, et montre que l’audit optimal est d’autant plus intense qu’il reste un nombre important d’interactions futures. L’intuition réside dans le fait que davantage d'audit au présent, quoique coûteux, a des répercussions informationnelles positives sur toutes les périodes suivantes. Enfin, le quatrième chapitre réunit les mécanismes de dissuasion et d’apprentissage dans un même modèle dynamique de réputation, avec des prestataires stratèges. Il montre l'existence d'une forme de dissuasion réputationnelle où l’apprentissage transforme la dissuasion en une menace intertemporelle. En d’autres termes, un prestataire sera davantage dissuadé dans le présent car il risque de détériorer sa réputation future s’il se fait attraper en train de frauder
Insurance fraud is a serious threat to insurance markets and is tackled through the design of credible and targeted auditing policies. This thesis studies the deterrence and learning mechanisms of insurance fraud audits, especially when service providers (car repairers, opticians, etc.) act as intermediaries between the insurer and the policyholders. The first chapter is an empirical assessment of the deterrence effects of auditing. It was conducted in collaboration with IBM France and PRO BTP, in the context of the deployment of the Solon counter-fraud solution. This assessment shows that incurred audits decrease an optician’s subsequent fraud. More specifically, the more credible the audit threat, the stronger this deterrence effect, emphasizing the importance of commitment in counter-fraud efforts. The second and third chapters examine a dynamic auditing problem where information plays a central role. The auditor interacts repeatedly with non-strategic service providers and can learn about their propensity to defraud from the auditing outcomes. The second chapter relies on a two-period model to show the existence of this learning effect, whose consequence is that it is optimal to audit more at the beginning of the relationship. The third chapter extends this model to an arbitrary or infinite number of periods, and shows that the further away the time horizon, the larger the optimal auditing efforts. Intuition stems from the fact that more auditing in the present, though costly, has a positive informational impact on all future periods. Finally, the fourth chapter combines the deterrence and learning mechanisms in the same dynamic reputation model, with strategic service providers. It reveals a reputation-based deterrence effect, where learning turns deterrence into an intertemporal threat. In other words, a service provider will be deterred more strongly in the present because of the risk of seeing his future reputation deteriorate if he gets caught defrauding
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Richards, Katie. "Fraud unravels all? : a critical examination of the fraud rules in marine insurance and documentary credit transactions." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/110284/.

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This thesis considers the extent to which ‘fraud unravels all’ explains the judicial response to fraudulent marine insurance claims and fraud in documentary credit transactions. The simplicity of the maxim suggests that fraud does not unduly trouble the courts and gives the impression of a uniform and deterrent approach to fraud within the civil law. The comparison made in this thesis demonstrates this impression to be misleading; the courts have conceived of fraud differently and have employed context-specific policy concerns to justify the shape of each fraud rule. The insurance discussions are dominated by deterrence with legal sanctions placed at the heart of the model. By contrast, the trade finance courts adopt a more laissez-faire attitude which prioritises the efficiency of the credit mechanism and considers deterrence an ex ante issue for the parties. Accordingly, this thesis examines the respective policy justifications and considers their continued validity in light of comparative and empirical evidence. In the insurance context, it is argued that the judicial understanding of deterrence is outdated which renders the resulting legal rule ineffective. An examination of approaches to fraud in other jurisdictions then demonstrates the possibility of constructing a more nuanced remedial framework which would balance the competing policy considerations of deterrence and proportionality. The documentary credit discussion contends that the narrow English approach to fraud is not an inevitable policy decision and moreover, has resulted in detrimental consequences for the credit mechanism. It employs empirical data to develop an explanation of deterrence for the duration of credit transactions. In both contexts, these arguments have important implications for the future development of the law. In summary, this research undermines the utility of ‘fraud unravels all’ and calls instead for courts and academics to resist instinctively attractive solutions in favour of a robust, empirically-informed approach to fraud.
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Ponce, Michael. "Healthcare fraud and non-fraud healthcare crimes: A comparison." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3233.

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Healthcare fraud is a major problem within the healthcare industry. The study examined medical fraud, its laws, and punishments on federal and state levels. It compared medical fraud to non-fraud crimes done in the healthcare industry. This comparison will be done on a state level. The study attempted to analyze the severity of fraud against non-fraud and that doctors would commit fraud offenses more often than non-fraud offenses.
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Shawyer, Andrea. "Investigative interviewing : investigation, counter fraud and deception." Thesis, University of Portsmouth, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.496605.

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Due to highly publicised miscarriages of justice cases towards the end of the last century in the UK, legislation and associated practice developed in an attempt to achieve more ethical investigations. Investigative interviewing as a result was developed, and progressed over the years to become one of the most ethical and fair systems of interviewing in the world. The introduction of the PEACE model in the early 1990s provided structure and form for all police interviewers, and more recently in public sector fraud interviews, and became a framework to which all interviewers should adhere.
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Mohamed, Mudzamir. "Countering fraud in the insurance industry : a case study of Malaysia." Thesis, University of Portsmouth, 2013. https://researchportal.port.ac.uk/portal/en/theses/countering-fraud-in-the-insurance-industry(3959e2cd-403b-4a18-86f7-99e89948ee19).html.

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Insurance fraud is noted as one of the most significant challenges to the financial stability of the insurance market (Wells, 2011; Yusuf & Babalola, 2009). The main purpose of this study is to explore and access the magnitude of the issues in a company setting and gather responses from the general environment regarding this threat. Due to the Malaysian cultural set up, there are gaps of research in this topic as fraud issues are considered sensitive and taboo. Although some researchers have shed some light on issues pertaining to fraud in Malaysia, however these studies have focused purely on mitigation and countering in the economic dimension without making relationship with authorities concerned. This study looks to support the idea of Malaysia‘s current Prime Minister, Dato Mohd Najib Tun Razak, which are encompassed in the 'Economic Transformation Plan'. During the start of his Prime Minister role he urged all sectors to be more transparent and responsive. Besides, the pattern of an economic downturn for a second wave in 2008 demanded the insurers to offer fewer products or services, and at the same time be more stringent on the policy inclusions (Bank Negara Malaysia (BNM), 2010). This research has examined a broad volume of articles from specific areas of fraud including cases of insurance fraud. This is done to grasp the fraud control strategies and the current trends in Malaysia. This research applies multiple research methods that comprise of interviews', observations and document inspections within the selected companies. This to facilitate the coherence and collaborative work of the authorities selected in the case study which are crucial in evaluating the process of countering fraud. In order to ensure the success of this study, it utilized and adopted the CIPFA Red Book 2 as the main benchmark to gauge the initiatives of countering fraud in the Malaysian insurance industry. The findings of the study revealed that there are two companies integrating good initiatives which enable them to avoid insurance fraud cases to a greater extent. However, one of the companies did not address the issues entirely as the operation of the working environment is atypical. All professionals agreed upon that this task, countering fraud and corruption, demands a certain set of skills. By that, this advocates the idea that countering fraud initiatives are not for a single performer imposition only. On the contrasting side, due to the hierarchy and supremacy in Malaysia, Bank Negara Malaysia (BNM) plays a vital role in the insurance market. However, they are still unwilling in making these concerns part of the national agenda since many companies have only recorded a satisfactory level in integrating the functions of combating fraud. However, specialists have urged some officials and relevant authorities, insurers and professionals in making precise arrangements to embark on the issues in an appropriate process.
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Roberts, Terisa. "The use of credit scorecard design, predictive modelling and text mining to detect fraud in the insurance industry / Terisa Roberts." Thesis, North-West University, 2011. http://hdl.handle.net/10394/10347.

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The use of analytical techniques for fraud detection and the design of fraud detection systems have been topics of several research projects in the past and have seen varying degrees of success in their practical implementation. In particular, several authors regard the use of credit risk scorecards for fraud detection as a useful analytical detection tool. However, research on analytical fraud detection for the South African insurance industry is limited. Furthermore, real world restrictions like the availability and quality of data elements, highly unbalanced datasets, interpretability challenges with complex analytical techniques and the evolving nature of insurance fraud contribute to the on-going challenge of detecting fraud successfully. Insurance organisations face financial instability from a global recession, tighter regulatory requirements and consolidation of the industry, which implore the need for a practical and effective fraud strategy. Given the volumes of structured and unstructured data available in data warehouses of insurance organisations, it would be sensible for an effective fraud strategy to take into account data-driven methods and incorporate analytical techniques into an overall fraud risk assessment system. Having said that, the complexity of the analytical techniques, coupled with the effort required to prepare the data to support it, should be carefully considered as some studies found that less complex algorithms produce equal or better results. Furthermore, an over reliance on analytical models can underestimate the underlying risk, as observed with credit risk at financial institutions during the financial crisis. An attractive property of the structure of the probabilistic weights-of-evidence (WOE) formulation for risk scorecard construction is its ability to handle data issues like missing values, outliers and rare cases. It is also transparent and flexible in allowing the re-adjustment of the bins based on expert knowledge or other business considerations. The approach proposed in the study is to construct fraud risk scorecards at entity level that incorporate sets of intrinsic and relational risk factors to support a robust fraud risk assessment. The study investigates the application of an integrated Suspicious Activity Assessment System (SAAS) empirically using real-world South African insurance data. The first case study uses a data sample of short-term insurance claims data and the second a data sample of life insurance claims data. Both case studies show promising results. The contributions of the study are summarised as follows: The study identified several challenges with the use of an analytical approach to fraud detection within the context of the South African insurance industry. The study proposes the development of fraud risk scorecards based on WOE measures for diagnostic fraud detection, within the context of the South African insurance industry, and the consideration of alternative algorithms to determine split points. To improve the discriminatory performance of the fraud risk scorecards, the study evaluated the use of analytical techniques, such as text mining, to identify risk factors. In order to identify risk factors from large sets of data, the study suggests the careful consideration of both the types of information as well as the types of statistical techniques in a fraud detection system. The types of information refer to the categories of input data available for analysis, translated into risk factors, and the types of statistical techniques refer to the constraints and assumptions of the underlying statistical techniques. In addition, the study advocates the use of an entity-focused approach to fraud detection, given that fraudulent activity typically occurs at an entity or group of entities level.
PhD, Operational Research, North-West University, Vaal Triangle Campus, 2011
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Books on the topic "Investigation of insurance fraud"

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American Bar Association. Tort Trial and Insurance Practice Section, ed. The insurance fraud deskbook. Chicago, Illinois: American Bar Association, Tort Trial and Insurance Practice Section, 2014.

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Stauf, Bruce W. Investigation of fraudulent casualty insurance claims. Atlanta, Ga. (5620 Glenridge Dr., Atlanta 30342): Crawford, 1993.

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Argraves, Neil. Private eyes handbook of insurance investigations. East Greenwich, R.I. (1050 Main St., East Greenwich 02818): Casualty Consultants, 1992.

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New York (State). Dept. of Audit and Control. Division of Management Audit. Non-profit health insurance companies, fraud prevention and detection activities. [Albany, N.Y: The Division, 1994.

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Hymes, Laura, and Joseph T. Wells. Insurance fraud casebook: Paying a premium for crime. Hoboken, New Jersey: Wiley, 2013.

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Stauf, Bruce W. Investigation of fraudulent workers compensation claims. Atlanta, Ga. (5620 Glenridge Dr., Atlanta 30342): Crawford, 1993.

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1964-, Finger Scott, ed. SIU 101: Special investigation units : guidelines, formats, procedures, forms, and philosophy for investigators and adjustors. Naperville, Ill: PSI Publications, 1994.

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Finance, United States Congress Senate Committee on. Anatomy of a fraud bust: From investigation to conviction : hearing before the Committee on Finance, United States Senate, One Hundred Twelfth Congress, second session, April 24, 2012. Washington: U.S. Government Printing Office, 2012.

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Dornstein, Ken. Accidentally, on purpose: The making of a personal injury underworld in America. New York: St. Martin's Press, 1996.

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Sins of the father. Chesterfield [England]: Crème de la Crime, 2006.

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Book chapters on the topic "Investigation of insurance fraud"

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Gottschalk, Petter. "Investigation Reports." In Fraud Investigation, 80–95. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-6.

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Gottschalk, Petter. "Introduction." In Fraud Investigation, 1–4. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-1.

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Gottschalk, Petter. "Misconduct Investigations in the United States." In Fraud Investigation, 178–98. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-10.

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Gottschalk, Petter. "Conclusion." In Fraud Investigation, 199–201. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-11.

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Gottschalk, Petter. "White-Collar Crime Research." In Fraud Investigation, 5–17. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-2.

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Gottschalk, Petter. "Theory of Convenience." In Fraud Investigation, 18–47. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-3.

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Gottschalk, Petter. "Convenience Research." In Fraud Investigation, 48–59. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-4.

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Gottschalk, Petter. "Crime Signal Detection." In Fraud Investigation, 60–79. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-5.

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Gottschalk, Petter. "Crime Investigations in Norway." In Fraud Investigation, 96–106. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-7.

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Gottschalk, Petter. "Misconduct Investigations in Scandinavia." In Fraud Investigation, 123–65. 1 Edition. | New York : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781351139069-8.

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Conference papers on the topic "Investigation of insurance fraud"

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Diaz-Granados, Manuel, Javier Diaz-Montes, and Manish Parashar. "Investigating insurance fraud using social media." In 2015 IEEE International Conference on Big Data (Big Data). IEEE, 2015. http://dx.doi.org/10.1109/bigdata.2015.7363893.

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Felcan, Miroslav. "Historical Cross-Section of Arson." In Safe and Secure Society. The College of European and Regional Studies, 2020. http://dx.doi.org/10.36682/ssc_2020/1.

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This work was supported by the Agency for Research and Development under the contract no. APVV-17-0217.Every year fires cause big damage to society, property, environment, buildings and infrastructure and pose a threat to life and health of persons in endangered areas. In most cases arson serves as insurance fraud or cover up any crime (e.g. robbery, embezzlement). However, there may be other reasons, e.g. in the case of the Commission of the European Union, the use of the product in envy, hatred, threats, blackmail, competitive struggle. Or social, political, or ethnic differences. In several cases, arson was used as a so-called 'arson attack'. The false flag, that is, the arsonist used the fire to accuse his enemy and took advantage of the wave of recourse that subsequently was raised against him. The circumstances of the cause and the fire are under investigation. After extinguishing a fire, it is standard procedure to seek and then either confirm, refute or further examine the possibility of intentional formation. In most countries of the world, arson is treated as a crime and seen as harming a stranger or a threat to life.
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Saldamli, Gokay, Vamshi Reddy, Krishna S. Bojja, Manjunatha K. Gururaja, Yashaswi Doddaveerappa, and Loai Tawalbeh. "Health Care Insurance Fraud Detection Using Blockchain." In 2020 Seventh International Conference on Software Defined Systems (SDS). IEEE, 2020. http://dx.doi.org/10.1109/sds49854.2020.9143900.

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Nur Prasasti, Iffa Maula, Arian Dhini, and Enrico Laoh. "Automobile Insurance Fraud Detection using Supervised Classifiers." In 2020 International Workshop on Big Data and Information Security (IWBIS). IEEE, 2020. http://dx.doi.org/10.1109/iwbis50925.2020.9255426.

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Liang, Chen, Ziqi Liu, Bin Liu, Jun Zhou, Xiaolong Li, Shuang Yang, and Yuan Qi. "Uncovering Insurance Fraud Conspiracy with Network Learning." In SIGIR '19: The 42nd International ACM SIGIR Conference on Research and Development in Information Retrieval. New York, NY, USA: ACM, 2019. http://dx.doi.org/10.1145/3331184.3331372.

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Kenyon, David, and J. H. P. Eloff. "Big data science for predicting insurance claims fraud." In 2017 Information Security for South Africa (ISSA). IEEE, 2017. http://dx.doi.org/10.1109/issa.2017.8251773.

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Peng, Jinfeng, Qingzhong Li, Hui Li, Lei Liu, Zhongmin Yan, and Shidong Zhang. "Fraud Detection of Medical Insurance Employing Outlier Analysis." In 2018 IEEE 22nd International Conference on Computer Supported Cooperative Work in Design (CSCWD). IEEE, 2018. http://dx.doi.org/10.1109/cscwd.2018.8465273.

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Roy, Riya, and K. Thomas George. "Detecting insurance claims fraud using machine learning techniques." In 2017 International Conference on Circuit ,Power and Computing Technologies (ICCPCT). IEEE, 2017. http://dx.doi.org/10.1109/iccpct.2017.8074258.

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Subudhi, Sharmila, and Suvasini Panigrahi. "Effect of Class Imbalanceness in Detecting Automobile Insurance Fraud." In 2018 2nd International Conference on Data Science and Business Analytics (ICDSBA). IEEE, 2018. http://dx.doi.org/10.1109/icdsba.2018.00104.

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Anbarasi, M. S., and S. Dhivya. "Fraud detection using outlier predictor in health insurance data." In 2017 International Conference on Information Communication and Embedded Systems (ICICES). IEEE, 2017. http://dx.doi.org/10.1109/icices.2017.8070750.

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Reports on the topic "Investigation of insurance fraud"

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Ravikumar, B., Yuzhe Zhang, and David L. Fuller. Unemployment Insurance Fraud and Optimal Monitoring. Federal Reserve Bank of St. Louis, 2012. http://dx.doi.org/10.20955/wp.2012.024.

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