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1
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 frauderInsurance 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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Hradilová, Zuzana. "Pojistné podvody." Master's thesis, Vysoké učení technické v Brně. Ústav soudního inženýrství, 2014. http://www.nusl.cz/ntk/nusl-232859.
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This diploma thesis deals with problems of insurance fraud in the Czech Republic. The thesis is decided into the several separate parts. The teoretical part describes characteristics of insuracne fraud itselfs, its classification, profile of fraud perpetor and reason of committing instance fraud at all. The next part describes detection of insurance fraud and the subsecvent procedure in investigating insurance fraud. The goal of practical part of diploma thesis is analysis of insurance fraud and questionnaire survey. There will be describe the prevetion of insurance fraud and in the end, there will be several specific cases of insurance fraud.
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Evans, Stephen. "Victim inequality and offender impunity : the asymmetric outcomes of motor insurance fraud." Thesis, University of Portsmouth, 2018. https://researchportal.port.ac.uk/portal/en/theses/victim-inequality-and-offender-impunity(21b058fd-1514-4b5e-9586-e544438318b5).html.
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This research examines whether the funding of IFED, a dedicated police unit, set up to deal exclusively with allegations of insurance fraud brought by those insurers providing the funding, has impacted the ability of non-insurer victims of insurance fraud to gain access to justice. The first stage of the research sought to identify and quantify the nature of fraud and its impact on both the insurance industry and on non-insurers. It included a desk-top review of the credit-hire sector, the local bus sector and large fleet-operators. The second stage involved a self-completion questionnaire to build econometric and experiential data from the credit-hire sector before effecting semi-structured interviews with twenty-nine witnesses working within or proximate to the area being investigated and conducting research and further interviews in respect of five case studies. An emergent theme was the use by the insurance industry of data, predominantly driven by uncorroborated estimates, that showed the industry to be impacted hugely by fraud, a conclusion that they had deployed to inspire a media and lobbying campaign to seek regulatory change protective of their business model whilst also gaining exclusive access to a dedicated police resource. Whilst no direct harm was reported by non-insurer victims because of the existence of IFED there was evidence of criminal offenders migrating to victims less capable of soliciting a police response and so gaming the system to gain impunity. The research posits an objective methodology for scoring the economic, societal or criminological validity of a privately-funded public-police initiatives with implications for future partnerships in other areas where business can contribute to the cost of law enforcement to assess whether enforcement success can feed directly through to the profit line but without inspiring victim inequality or offender impunity. Whilst the Police had, prior to the Fraud Review and the creation of IFED, demonstrated limited enthusiasm for investigating allegations of fraud, the creation of IFED, accompanied with the effects of austerity measures on policing, has had a meaningful and detrimental impact on the ability of certain non-insurers to deal with insurance fraud relative to the protection available to insurers. The identity of the victim made a difference. The partisan approach to a single victim-set may be contributing to the growth of insurance fraud facilitated by organised criminals and increasing the likelihood of impunity for offenders committing acquisitive vehicle offences involving the rental and credit-hire industries.
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Titus, Phyllis May. "Medical schemes fraud : ethical investigation of medical practitioners as stakeholders." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020899.
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A mere 16 percent of the population enjoys the benefits of private healthcare; medical schemes however remain an important contributor to the South African economy with an annual contribution flow of close to R85 billion per annum. Similar to the international scenario, South African healthcare inflation surpassed consumer price inflation. In addition, the medical schemes industry remains riddled with fraud, this coupled with escalating private healthcare costs remain subsequent threats to the sustainability of the industry. It is reported that service provider fraud has surpassed fraud committed by scheme members. Most medical schemes appear to have policies in place to manage and combat fraud, however transparency in terms of information sharing remains elusive. Of greater concern have been the investigation and management ethicality and endgame of medical schemes in terms of fraud risk management amongst medical practitioners. The research problem states that there is currently no standard fraud investigation and management protocol available for the ethical investigation and management of medical schemes fraud committed by medical practitioners. The literature review demonstrated that there has been a paradigm shift regarding the expectations that society has of the modern corporation and emphasised the inclusive stakeholder model theory in favour of the traditional shareholder dictum: pursuit of profit maximisation at any cost. The research design was done by providing a survey questionnaire to private medical practitioners. The literature review and survey findings highlighted the need for medical schemes to pay greater heed to their ethicality and stakeholder issue management practices. Focus areas for the development of an industry standard fraud investigation and management protocol was recommended.
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Zheng, Rui. "Fraudulent claims in commercial insurance law : a legal and economic analysis." Thesis, Swansea University, 2012. https://cronfa.swan.ac.uk/Record/cronfa42644.
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Insurance fraud is perhaps one of the most pressing problems challenging the insurance industry. The judiciary plays a significant role in tackling insurance fraud: the burden is on their shoulders to identify the appropriate legal rules governing fraudulent claims and determining the consequences of fraud. However, regrettably, this process has long remained elusive and in the recent decades the courts have tried but failed to formulate clear principles for the treatment of insurance fraud, so the process is, still, continuing. This judicial process is not free from difficulty particularly with regard to the consequence of presenting fraudulent claims. The failure of judicial attempt to formulate clear principles in this jurisdiction has attracted the attention of the Law Commissions which intend to pursue a reform at the legislative level. At the current stage, the law seems to stand at a turning point and try to adapt itself to the new situation. The author is of the opinion that this is the right time to provide a full-scale research in the jurisdiction of insurance fraudulent claims for the purpose of identifying the existing difficulties and confusions, shaping the appropriate legal regime and contributing to the evolving reform process of English insurance contract law. The author is also of the opinion that considering the viability of reform proposals from a novel perspective, namely economics and law, might add a very interesting dimension to the debate. It is believed that the law and economics debate would be helpful in explaining the outcomes of certain legal solutions and identifying the most appropriate legal remedy. Finally, the author also intends to examine to what extent the Law Commissions' proposal could be defended in the light of author's legal and economic analysis.
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Yang, Dan. "Financial fraud in Chinese stock exchange listed companies." Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=163152.
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This thesis develops an analysis of the prevalence and determinants of financial fraud as identified in the Chinese listed firms over the period 1996 to 2007. First, theoretical analysis on the determinants of financial fraud, from its subjective, objective and conditional aspects, provides an understanding of why financial fraud happened as it did. The conditional aspect (corporate governance mechanisms) is highlighted since it is controllable in reducing the probability of fraudulent reporting. Data from the Chinese stock market is accessed, organised, and analyzed to support the analysis. Second, the prevalence and nature of fraud uncovered in the supervision of listed companies in Chinese stock exchanges is identified. From data reported by the China Securities Regulatory Commission, the incidence and prevalence of cases of fraud identified through regulation is investigated. I show how fraudulent activity can be categorised, how its nature has evolved over time, how business sectors are differentially prone to fraud, and what modes of fraudulent activity have been recorded. Third, the key interest of this research lies in the investigation of the argument that companies are more, or less, prone to fraudulent reporting by reason of: Their ownership structure; Their corporate governance characteristics; and/or Their numerical characteristics in financial reporting. 82 fraudulent financial statements from 40 listed companies identified by the China Securities Regulatory Commission are selected as the study sample, and 82 control peers are selected, to correspond to the study sample as closely as possible, regarding the assets size and industries. Findings challenge the conventional arguments which have been supported based on data from western countries. Conventional arguments show financial fraud is associated with weakness of governance in western companies (e.g. Beasley et al., 2000) and with patterns of ownership that would indicate reduced agency control by shareholders. However, my finding reveals that in China ownership concentration is negatively associated with reported fraud; and as for some oft-discussed corporate governance characteristics (e.g. the supervisory board, audit committee, independent directors), the fraud firms and their non-fraud peers are not statistically distinct, suggesting that corporate governance mechanisms that are designed to reduce the probability of financial fraud fail to work in the Chinese market. The negative results in this research contribute by updating our understanding of the determinants of financial statement fraud; the supervision of China’s equity markets; and whether it can be considered effective in uncovering financial fraud.
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Longino, Chris. "Organized Crime in Insurance Fraud: An Empirical Analysis of Staged Automobile Accident Rings." Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5731.
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The growing trend of insurance fraud continues to cost US consumers billions of dollars a year through increased premiums. In 2015, the Coalition Against Insurance Fraud estimated the cost of insurance fraud as being at least $80 billion dollars a year. Even though an increasing number of criminals are drawn to the low risk, high reward of insurance fraud, little criminological literature has explored this topic and the public remains relatively unaware of the extent of the problem.
One alarming aspect of insurance fraud is the involvement of organized criminal groups. These organized criminal enterprises are formed for the sole purpose of defrauding the insurance industry. Often, these enterprises are believed to have ties to traditional organized criminal groups, such as the Italian Mafia or the Russian Mob. In order to combat these criminal organizations, it is important to understand the behavior and motivation of such groups.
The present study aims to analyze the generally held belief throughout the insurance industry that organized insurance fraud rings are more likely to operate in states with mandatory Personal Injury Protection (PIP) policies. This analysis was conducted by examining staged automobile accidents reported to the National Insurance Crime Bureau. The results of this analysis were mixed. Although a larger percentage of states with mandatory PIP displayed higher staged accident rate, some mandatory PIP states did not, and multiple non-PIP states also demonstrated a high staged accident rate. In an attempt to better understand this crime, further criminological research is needed.
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Rowson, David. "The problem with fraudulent solicitors : issues of trust, investigation and the self-regulation of the legal profession." Thesis, Teesside University, 2009. http://hdl.handle.net/10149/112684.
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Jastremská, Kateřina. "Problematika pojistných podvodů na českém pojistném trhu." Master's thesis, Vysoká škola ekonomická v Praze, 2015. http://www.nusl.cz/ntk/nusl-205752.
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The thesis deals with insurance fraud on the Czech insurance market. The introductory section describes the actual state of the insurance market. Insurance fraud is presented in terms of legislation, their species and the general alarming indicators. The next section deals with internal fraud and depictures a brief profile of the typical internal fraudster, indicators of their suspicious behavior and ways of prevention. The following chapter describes the external fraud in the life and non-life insurance, and is supplemented by a separate chapter describing organized fraud. The following part is devoted to statistics of insurance fraud, both from the perspective of the Czech Republic as well as some European countries. The final section describes several fraud detection methods used by insurance companies. Finally, the author proposes certain ways of improving the efficiency of the fight against this crime.
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Al-Marzouki, Sanaa Mohammed. "A statistical investigation of fraud and misconduct in clinical trials." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2006. http://researchonline.lshtm.ac.uk/1386836/.
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Research misconduct can arise In any area of research and can discredit the findings. Research misconduct at any level is unacceptable, especially in a clinical trial. Because the results from clinical trials are used to decide whether or not treatments are effective, and affect decisions that may influence treatment choices for large numbers of patients, the prevention and detection of scientific misconduct in clinical trials is particularly important. Chapter 1 outlines some definitions of research misconduct, discusses the underlying motivations behind it, and the overall prevalence of research misconduct beyond that occurring in clinical trials. Different ways to detect and prevent research misconduct are also presented. In addition, an initial insight into the types of scientific misconduct that have been reported as occurring in clinical trials, based on a search of the PubMed database between January 2000 and July 2003 is provided. Thirty-eight published reports were found, but they provide no indication of the relative importance of different types of scientific misconduct in clinical trials. Chapter 2 presents a three-round Delphi survey aimed at achieving consensus among experts in clinical trials on what types of scientific misconduct are most likely to occur, and are most likely to influence the results of a clinical trial. This study identified thirteen forms of scientific misconduct for which there was consensus (>50%) that they would be likely or very likely to distort the results and consensus (>50%) that they would be likely or very likely to occur. Of these, the over-interpretation of 'significant' findings in small trials, selective reporting and inappropriate sub-group analyses were the main themes. To prevent such types of misconduct in clinical trials, the issue of selective reporting of outcomes or sub-group analyses and the opportunistic use of the play of chance (inappropriate sub-group analyses) should be addressed. Full details of the primary and secondary outcomes and sub-group analyses need to be specified clearly in protocols. Any sub-group analyses reported without pre-specification in the protocol would need supporting evidence within the publication for them to be justified. Chapter 3 explores selective reporting and inappropriate sub-group analyses within a cohort of randomised trial protocols approved by the Lancet. It determines the prevalence of selective reporting of primary and secondary outcomes and sub-group analyses in published reports of randomised trials. It also examines how sub-group analyses are described in protocols and how sub-group analyses are reported, and whether they match those specified in the protocol. Of 56 accepted protocols, four non-randomized trials were excluded. For the remaining 52, permission to review them was obtained for 48 (92%). Of those 48 trials, 30 (63%) trials were published. This study identifies some shortcomings in the reporting of the results of primary and secondary outcomes and sub-group analyses. It shows at least one unreported primary, secondary or sub-group analysis in 37%, 87%, and 50% of the trials, respectively. It also shows that the pre-specification and reporting of sub-group analyses are often incomplete and inaccurate. The majority of protocols gave hardly any detail on this matter. There was notable deviation from the protocols in reports in several of the trials. Data fabrication and falsification were judged by the experts in the Delphi survey to be unlikely to occur. However, they can have major effects on the outcomes of clinical trials if it they do occur. A systematic review was conducted in chapter 4, to identify the available statistical techniques that could be used for the detection of data fabrication and falsification. Chapter 5 examines the ability of these statistical techniques to detect data fabrication in data from two randomised controlled trials. In one trial, the possibility of fabricated data had been raised by British Medical Journal (BM) referees and the data were considered likely to contain fraudulent elements. For comparison, a second trial, about which there were no such concerns, was analysed using the same techniques, and no hint appeared of any unusual or unexpected features was shown. Finally, chapter 6 contains some concluding remarks, a discussion of the strengths and weaknesses of this research and suggestions for future research.
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Clement, Junior V. "Strategies to Prevent and Reduce Medical Identity Theft Resulting in Medical Fraud." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4843.
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Medical identity fraud is a byproduct of identity theft; it enables imposters to procure medical treatment, thus defrauding patients, insurers, and government programs through forged prescriptions, falsified medical records, and misuse of victim's health insurance. In 2014, for example, the United States Government lost $14.1 billion in improper payments. The purpose of this multiple case study, grounded by the Health Insurance Portability and Accountability Act as the conceptual framework, was to explore the strategies 5 healthcare leaders used to prevent identity theft and medical identity fraud and thus improve business performance in the state of New York. Data were collected using telephone interviews and open-ended questions. The data were analyzed using Yin's 5 step process. Based on data analysis, 5 themes emerged including: training and education (resulting to sub-themes: train employees, train patients, and educate consumers), technology (which focused on Kiosk, cloud, off-site storage ending with encryption), protective measures, safeguarding personally identifiable information, and insurance. Recommendations calls for leaders of large, medium, and small healthcare organizations and other industries to educate employees and victims of identity theft because the problems resulting from fraud travel beyond the borders of medical facilities: they flow right into consumers' residences. Findings from this study may contribute to social change through improved healthcare services and reduced medical costs, leading to more affordable healthcare.
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Krop, Filip. "Problematika pojistných podvodů v rámci pojištění automobilů v ČR." Master's thesis, Vysoká škola ekonomická v Praze, 2013. http://www.nusl.cz/ntk/nusl-199292.
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The diploma thesis concerns an instance fraud issue focused on fraud related to car insurance. The aim of the work is to analyze the fight of insurance companies against frauds, the activities which are set up to prevent the occurrence of the infringement and the acts companies do in order to prevent or reduce the damage already done. Furthermore, the effects of these actions to clients are formulated and in the end the work gives suggestions on how to improve the efficiency of the fight against insurance fraud.
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Augusta, Jindřich. "Srovnání Fraud Managemet Systémů z pohledu společnosti/zákazníka (na co si dát pozor a na co se zaměřit při výběru vhodného řešení)." Master's thesis, Vysoká škola ekonomická v Praze, 2009. http://www.nusl.cz/ntk/nusl-19108.
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Diploma thesis deals with fighting insurance fraud from the very beginning to the end, seen from insurance company's perspective. It also tries to see insurance frauds and dealing with them not only from IT point of view, but also accompany other department's views and needs. It's starting with organizational overview and its readiness to fight fraud and trying to show, how to improve. Furthermore it introduces reader with basic terms and phrases of insurance fraud and continues with general description of this encounter. It continues with indicators of insurance fraud and its examples and strategies, how to find them in data. Next part of my thesis is focusing on available external sources and possible insurance companies' cooperation, for maximized ability to detect suspicious cases. This is continued by selection of proper system, requirements definition and its goals. Last part shows one of FMS solutions and its description, from requirements up to complete solutions architecture and screenshots of given system.
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Gentry, Jim. "An investigation into fraud and unethical conduct in the construction industry." Thesis, Monterey, California. Naval Postgraduate School, 1990. http://hdl.handle.net/10945/26016.
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Searl, Theresa Amelia Frances. "The investigation and prosecution of serious fraud in England and Wales." Thesis, University of Sheffield, 2004. http://etheses.whiterose.ac.uk/3547/.
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This study sought to examine the principles and practice of investigation and prosecution of serious fraud by criminal justice agencies within the English and Welsh legal system. It commenced with an examination of the literature in relation to the status of fraud within the English legal system together with that in relation to the principles and operation of several of the agencies identified as dealing primarily with fraud. This identified that the English legal system did not recognise fraud as an offence and that the criminal and civil justice systems dealt with what was popularly accepted as constituting "fraud". To make meaningful analysis of the systems' response to this, the study would have to be confined to a specific type of fraud and to either the civil or criminal the branches of the justice system. Fraud committed by companies or individuals against other companies or individuals, involving large sums of money, and dealt with by the criminal justice system was adopted as the focus of the study. The main agencies responsible for this type of fraud were identified as being the police, the Crown Prosecution Service; the Serious Fraud Office and the Department of Trade and Industry. Examination of the literature revealed the possible overlap of remit and operation between these and regulatory agencies. Access was granted to the staff and files of police, CPS and DTI. Approximately three months was spent conducting fieldwork in the offices of each of these agencies; interviewing staff, examining files and attending case conferences. Examination of these agencies operation revealed common themes that supported a conclusion that fraud was not a high priority within the criminal justice system. The lack of a substantive offence of fraud is discussed and analysis made of the results with a view to possible improvements to the current systems.
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Osisiogu, Udo Chikezie. "Criminal fraud : an investigation into the manipulation of trust and confidence." Thesis, University of Hull, 2001. http://hydra.hull.ac.uk/resources/hull:5425.
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Labuschagne, Mario. "The role of internal auditors with specific reference to fraud investigation." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/d1021385.
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The role of internal auditors is evolving to enable them to provide stakeholders with assurance and to assist organisations to achieve objectives and remain competitive to ensure the future existence of their organisations. The research for this study was guided by the question of whether the Institute of Internal Auditors guidance pronouncements provide sufficient guidance in the light of expectations of both the institute and management (stakeholders) relating to the role of internal auditors in respect of fraud investigation. Literature reviewed on the role of internal auditors showed that there is limited guidance provided with regards to fraud investigation, knowledge and skills required by an internal auditor to perform fraud investigations. The research methodology used for this study consisted of a qualitative case study of the Nelson Mandela Metropolitan University committees, namely, Council, Senate and MANCO as well as a combination of deductive and inductive interpretative analysis methods. Semi-structured interviews were used to obtain data from participants who were randomly selected from Nelson Mandela Metropolitan University Council, Senate and MANCO committees. The interviews revolved around three themes, namely, the role of internal audit, the information expected from internal audits and the role that the internal audit plays with regard to fraud. The interviews were recorded by means of a digital voice recorder which were transcribed by a qualified transcriber. The collected data was then manually coded by making use of standardised coding methods to assist with the analyses of the data. After considering the participant responses in relation to the themes, it could be deduced that a greater awareness needed to be created regarding the role of the internal audit and the services which internal audits could provide to organisations and management structures. The results of the analyses revealed that an expectation gap existed with regard to the Institute of Internal Auditors, guidance pronouncements and stakeholder expectations of internal auditor roles with specific reference to fraud investigations. This study showed that the IIA’s guidance pronouncements do not provide sufficient and adequate guidance in respect of the knowledge, skills and competency capabilities in relation to fraud investigations.The results of the study further showed that the expected role of internal auditors in an organisation should include fraud investigations.
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Chui, Lawrence. "An Experimental Examination of the Effects of Fraud Specialist and Audit Mindsets on Fraud Risk Assessments and on the Development of Fraud-Related Problem Representations." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc30447/.
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Fraud risk assessment is an important audit process that has a direct impact on the effectiveness of auditors' fraud detection in an audit. However, prior literature has shown that auditors are generally poor at assessing fraud risk. The Public Company Accounting Oversight Board (PCAOB) suggests that auditors may improve their fraud risk assessment performance by adopting a fraud specialist mindset. A fraud specialist mindset is a special way of thinking about accounting records. While auditors think about the company's recorded transactions in terms of the availability of supporting documentations and the authenticity of the audit trail, fraud specialists think instead of accounting records in terms of the authenticity of the events and activities that are behind the reported transactions. Currently there is no study that has examined the effects of the fraud specialist mindset on auditors' fraud risk assessment performance. In addition, although recent studies have found that fraud specialists are more sensitive than auditors in discerning fraud risk factors in situation where a high level of fraud risk is present, it remains unclear whether the same can be said for situation where the risk of fraud is low. Thus, the purpose of my dissertation is to examine the effects of fraud specialist and audit mindsets on fraud risk assessment performance. In addition, I examined such effects on fraud risk assessment performance in both high and low fraud risk conditions. The contributions of my dissertation include being the first to experimentally examine how different mindsets impact fraud-related judgment. The results of my study have the potential to help address the PCAOB's desire to improve auditors' fraud risk assessment performance though the adoption of the fraud specialist mindset. In addition, my study contributes to the literature by exploring fraud-related problem representation as a possible mediator of mindset on fraud risk assessment performance. I executed my dissertation by conducting an experiment in which mindset (fraud specialist or audit) was induced prior to the completion of an audit case (high or low in fraud risk). A total of 85 senior-level accounting students enrolled in two separate auditing classes participated in my study. The results from my experimental provide empirical support that it is possible to improve auditors' fraud risk assessment through adapting the fraud specialist mindset. My study also provides preliminary evidence that individuals with the fraud specialist mindset developed different problem representations than those with the audit mindset.
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Ai, Jing 1981. "Supervised and unsupervised PRIDIT for active insurance fraud detection." 2008. http://hdl.handle.net/2152/17724.
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This dissertation develops statistical and data mining based methods for insurance fraud detection. Insurance fraud is very costly and has become a world concern in recent years. Great efforts have been made to develop models to identify potentially fraudulent claims for special investigations. In a broader context, insurance fraud detection is a classification task. Both supervised learning methods (where a dependent variable is available for training the model) and unsupervised learning methods (where no prior information of dependent variable is available for use) can be potentially employed to solve this problem. First, an unsupervised method is developed to improve detection effectiveness. Unsupervised methods are especially pertinent to insurance fraud detection since the nature of insurance claims (i.e., fraud or not) is very costly to obtain, if it can be identified at all. In addition, available unsupervised methods are limited and some of them are computationally intensive and the comprehension of the results may be ambiguous. An empirical demonstration of the proposed method is conducted on a widely used large dataset where labels are known for the dependent variable. The proposed unsupervised method is also empirically evaluated against prevalent supervised methods as a form of external validation. This method can be used in other applications as well. Second, another set of learning methods is then developed based on the proposed unsupervised method to further improve performance. These methods are developed in the context of a special class of data mining methods, active learning. The performance of these methods is also empirically evaluated using insurance fraud datasets. Finally, a method is proposed to estimate the fraud rate (i.e., the percentage of fraudulent claims in the entire claims set). Since the true nature of insurance claims (and any level of fraud) is unknown in most cases, there has not been any consensus on the estimated fraud rate. The proposed estimation method is designed based on the proposed unsupervised method. Implemented using insurance fraud datasets with the known nature of claims (i.e., fraud or not), this estimation method yields accurate estimates which are superior to those generated by a benchmark naïve estimation method.text
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Govender, Prabashnie. "The value of modus operandi in fraud investigation : a short-term insurance industry perspective." Diss., 2018. http://hdl.handle.net/10500/26791.
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This study sought to examine the value of modus operandi (MO) information in the investigation of short-term insurance fraud. A comprehensive literature study was conducted concerning the dynamics of MO information in forensic investigation and short-term insurance fraud in South Africa and internationally, and individual semi-structured interviews were conducted with forensic investigators at Santam and MiWay to promote knowledge and understanding of the importance of MO information in short-term insurance fraud investigations.
Results of this research indicate that participants did grasp the significance of MO information in the investigation of short-term insurance fraud. It is, however, apparent that they did not optimally exploit MO information regarding insurance fraud as a result of limited experience, ineffective databases and the inaccessibility of available data – all of which prevent the improvement of utilising MO data pertaining to short-term insurance fraud. Forensic investigators in the short-term insurance industry isolate themselves from each other and fail to share the available MO information amongst each other, resulting in a non-systematic fragmented approach to short-term insurance fraud investigation. The study identifies the challenges and shortcomings experienced by forensic investigators at Santam and MiWay that prevent the optimal utilisation of MO information in the investigation of short-term insurance fraud. The study then suggests a set of recommendations that could assist forensic investigators and other role-players in enhancing the utilisation of such information.Criminology and Security Science
M. Tech. (Forensic Investigation)
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Hsu, Li-Kang, and 徐力剛. "The Research of Criminal Investigation and Prevention of Life Insurance Fraud for Taiwan and China." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/27019028616100457752.
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碩士淡江大學
保險學系保險經營碩士班
101
With the rapid development of the economy in recent years, many countries have prospered from developing into developed countries. The level of national education has increased so as to the acceptance of insurance, which leads to the popularity of insurance. But with the insurance density and insurance penetration gets higher, the insurance fraud case emerges. According to the estimate of Taiwan Insurance Institute (TII), Taiwan had paid extra compensation about one-tenth amount of the original claims due to the insurance fraud each year. By estimated 2012 life insurance industry, the total insurance amount paid were 1229474 (million), and the insurance fraud paid is 122947.4 (million), it takes 4.7% of total insurance income that year. After the end of culture revolution in 1980 in China, the government allowed the establishment of local insurance companies. The insurance industry has prospered. The China life insurance company, which has the highest capitalization in china, having paid extra benefits due to the insurance crime every year. The research discusses about criminal investigation and prevention of life insurance fraud for Taiwan and China. Author collects and analyzes major life insurance criminal events recent years in Taiwan, and had classified into four categories, including life insurance, health insurance, accident insurance and others. In order to help police and insurance company when they are investigating the insurance fraud, it had listed each type of crime process and supplement with actual case. The research majorly uses literature search and expert interview method, like collecting paper of Taiwan, China and overseas. Analyzing nowadays practical way of preventing insurance crime from each countries, and take legally point of view especially from Europe and America, which has more mature insurance development, to be references when proceeding insurance fraud prevention of Taiwan and China in the future. When author being an exchange student in China, he had interviewed several China insurance experts. And manager of claim department of Taiwan insurance company, executives of Life insurance association of the Republic of China, Consultant Survey Company and Insurance experts and scholars …etc. He had interviewed with a total of twelve professionals in all areas, which has related insurance backgrounds, seven in China and five in Taiwan. We expect that through different background and interaction of Taiwan and China, it can benefit the healthy development of insurance in the future. Finally, for the lack part of current prevention of insurance fraud in Taiwan’s insurance industry. Here come up with several recommendations by targeting insurance company, supervision department and future cross-strait cooperation, expecting to effectively prevent insurance crimes.
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Visser, Bennet Louis. "The significance of physical surveillance as a method in the investigation of insurance fraud: a Discovery Life perspective." Diss., 2015. http://hdl.handle.net/10500/20182.
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Text in EnglishThe primary aim of this study is to determine the significance of the application of physical surveillance as a method in the investigation of insurance fraud conducted by the Surveillance Unit at the Forensic Department of Discovery Life. Various objectives were fulfilled in this study: To explore, identify and describe the value of the application of physical surveillance, as a forensic investigation method, in order to determine the significance of this method in the investigation of insurance fraud at the Forensic Department of Discovery Life. To determine whether the application of physical surveillance at the Forensic Department of Discovery Life is achieving its intended objective relating to the degree to which the beneficiary’s (Discovery Life) situation has changed as a result of this method. To apply new information, acquired from the findings of this study, to further develop good practice and enhance performance in order to empower investigators at Discovery Life with new knowledge relating to the application of physical surveillance in the investigation of insurance fraud. Semi-structured interviews were conducted with forensic investigators employed at the Forensic Department at Discovery Life. The research has revealed that the majority of forensic investigators, other than the Surveillance Unit, at the Forensic Department of Discovery Life do not utilise physical surveillance during insurance fraud investigations to assist them in gathering evidence. These investigators also had a lack of knowledge and skills regarding the utilisation of physical surveillance during insurance fraud investigations and the advantages of this method during insurance fraud investigations. As a result of the non-utilisation of physical surveillance during insurance fraud investigations conducted at the Forensic Department of Discovery Life, important information and evidence with regard to the movement and actions of identified perpetrators who commit insurance fraud are lost to the investigators. However, the significance of the application of physical surveillance in the investigation of insurance fraud is emphasised by the forensic investigators attached to the Surveillance Unit of Discovery Life who utilise physical surveillance on a daily basis to investigate insurance fraud. The research has further revealed that insurance fraud is a major concern to the insurance industry, but can be mitigated through the implementation of unconventional investigative methods, such as physical surveillance, to enhance investigative capabilities. It was recommended that all forensic investigators at Discovery Life be trained in the techniques of physical surveillance to address shortcomings of general and out-dated investigation methods.
Criminology and Security Science
M. Tech. (Forensic Investigation)
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Mostert, Deanne. "Profiling of white-collar crime perpetrators in the short-term insurance industry in South Africa." Diss., 2018. http://hdl.handle.net/10500/24523.
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In the context of violent crimes and criminal investigations, the effectiveness and proven success of offender or criminal profiling have been well documented. In reference to white-collar crime perpetrators offenders, this is a much less documented topic though.
For any organisation to function effectively and be profitable there is huge reliance placed on employees. There is an expectation that the employees will carry out their functions with honesty and integrity while having the employer’s best interests in mind. Recent local and international published fraud surveys reported widely on the growing trend that has become known as the insider threat. This trend relates to the actual occurrence of misconduct by staff members and has increased proportionally over the years, i.e. from 55% in 2010 to a staggering 81% in 2015. The aim of this research was to determine how to profile staff members who commit white-collar crime in the South African short-term insurance industry. In addition, this research also focused on an introduction on the South African short-term insurance industry, as well as the suggested sources to consider when profiling staff as potential white-collar criminal perpetrators and the importance of making use of crime linkage analysis.
Results of this research include that the main objective of profiling will at all times be to perform a structured social and psychological assessment of the perpetrator and when conducting the profiling of potential white-collar criminal perpetrators, there are specific offender characteristics to consider, and detailed data will be required pertaining to certain categories.Police Practice
M. Tech. (Forensic Investigations)
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Ko, Ya-Ling, and 柯雅玲. "A Study on Insurance Fraud." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/79ar45.
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碩士國立臺灣大學
科際整合法律學研究所
105
With the increasing dependence of the modern society on the insurance system, the stability of the insurance system is very important for the individual, the family, and the society. Every country is committed to the prevention of insurance fraud because it not only damages the stability of the insurance system but also is accompanied by criminal offences frequently. In 2008 and 2015, Japan and the United Kingdom enacted new insurance law including special provisions to solve insurance fraud. However, Taiwan has not yet enacted provisions like those. To begin with, this paper will introduce the current situation of anti-insurance fraud in Taiwan from these three aspects: legislative level, administrative level and the insurance industry. Then, this paper will introduce the Japanese and British insurance law relates to anti-insurance fraud. Furthermore, can the insurer terminate the contract when the policyholder, the insured, or the beneficiary commits insurance fraud if there are such terms in the insurance policy? Finally, this paper will draw some conclusions and give some advice. It is hoped that the discussion in this article will serve as a reference for future amendments to the relevant law.
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CHANG, KAI-JAY, and 張凱傑. "The Life Insurance Agents' Attitudes toward Customer Insurance Fraud." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/7hf8p7.
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碩士逢甲大學
風險管理與保險學系
106
With higher education standard, people realize that insurance not only compensate loss to danger but also stable development of economy. Compare to past, the willing of buying insurance is higher, so is insurance fraud. Insurance fraud obviously violates the meaning of insurance, increases social cost and causes higher rate so that getting insurance is more difficult to people. This study is based on salesperson and fraud by taking former researches as references. By making questionnaire to Taiwan insurance salespersons and recycling result for data quantify, we understand the attitude toward the customer when fraud happens. Through these data, we subjectively analyze the result and give our point of view for future study.
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Pan, Wen-Chung, and 潘穩中. "Insurance Fraud Prevention from the Perspective of Insurance Law." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/89904647949592029943.
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碩士國立臺灣大學
法律學研究所
101
Insurance fraud which occurs frequently has been tackled by insurance practice and related regulations. With more observation, they put more efforts to establish the preventive norms, especially on the fraudulent claim after the occurrence of insurance accident. However, there are varieties of insurance fraud which is not limited to the cases mentioned above. Besides, according to Article 29 Section2 at Insurance Law, the insurance contract can survive even though the fraud done by the insured wrecks a havoc on the reliance between the insurer and insured, needless to say the insurer is able to terminate the contract by Insurance Law. Taiwan Insurance Law contains myriads of disadvantages. In lieu of these, it is suggested to adopt with some rule such as clausula rebus sic stantibus, the rule of continuous contract in civil law and regulations on special provisions in Insurance Law. Albeit, there are still insufficient to handle all problems. As to clausula rebus sic stantibus, the conditions of the rule is not so concrete and full of limitation to fulfill its purpose. Take the rule of continuous contract for another example, judges would be reluctant to utilize it because of lack of accurate regulations. Even though we put more hopes on special provisions in Insurance Law, it is still limited to Article 54-1and eventually becomes unavailable on solutions. With the perception of these problems, there is the tremendous amendment in Japanese Insurance Law in 2008, including the addition on fundamental termination regulation to provides with more concrete and instructive solutions to insurance fraud. In a nutshell, the thesis try to provides with legislative suggestion and proposes some drafts with the introduction these development to Taiwan Insurance Law .
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Poissant, Mathieu. "Statistical methods for insurance fraud detection." Thèse, 2008. http://hdl.handle.net/1866/8191.
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Chen, Po-Wen, and 陳泊文. "The Research of Life Insurance Fraud." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/15865041529594434006.
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碩士淡江大學
保險學系保險經營碩士在職專班
98
Abstract: Deceptions of medical insurance claim on medical treatments have caused severe problems for the insurance industry and the social welfare system of National Health Insurance. Criminal cases triggered by insurance frauds also have negative influences on the public and the society. If problems of fraud claims of the like cannot be controlled, the society and economics will be facing with more strikes. By collecting a variety of insurance fraud cases and analyzing statistic data, this thesis expects to reveal characteristics of insurance fraud, behavior patterns, and criminal behaviors. By interviewing insurance specialists, this thesis also conducts a comparative study with reference to foreign cases in prevention or reduction of insurance frauds. In such, instruments are provided here to deal with insurance fraud cases in Taiwan in the near future. This study intends to provide life insurance enterprises, competent authorities, and National Health Insurance respectively with suggestions against insurance frauds. Three fields of suggestions are listed as follows: 1 Suggestions to Insurance Enterprises: 1.1 Control new business underwriting 1.2 Enhance professional knowledge of claim specialists and underwriters 1.3 Establish business quality and agency management 1.4 Evaluate insurance product property 2 Suggestions to Competent Authorities: 2.1 Promulgate and enact laws for insurance fraud 2.2 Establish special courts and investigation bureaus for insurance fraud 2.3 Amend related insurance regulations 2.4 Grant investigation power to insurance enterprises 2.5 Reinforce functionality of The Insurance Anti-fraud Institute (IAFI) 3 Suggestions to the Bureau of National Health Insurance 3.1 Enhance the information sharing system with insurance enterprises 3.2 Enhance internal control and audit functions
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CHEN, PO-TSANG, and 陳伯滄. "On Insurance Fraud and Preventive Measures." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/zb7h82.
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碩士東吳大學
法律學系
106
Insurance is a kind of usage of principle in separated risks and sharing damages.It is done by numbers of people through sharing with this risks which are put on some people. Taiwan Insurance Institute estimates that insurance companies in Taiwan have to pay about 10 percent of insurance claim for the fraud,the total amount each year about 30 billion NT dollars.This is a big black hole for the insurance companies.Without making a proper prevention project,it will be the serious damage for the bona fide third party’s rights and benefits.The victims of insurance fraud are not only the insurer who pays the insurance bebefits but also the insured whose rights and privileges are supposed to be protected.This article is an attempt to provide an analysis on different types of insurance fraud and thereby assess the adequacy of the legal rules in governing insurance frauds and give recommendations for reducing the possibility of insurance frauds. The objective of this study is described as follows: First, exploring the type of crime of insurance fraud based on relevant judgment data in Taiwan. Second, exploring the Causes, Motives and Process of Insurance Fraud. Third, according to the research results, the countermeasures against the fraud of insurance are put forward for the reference of criminal investigation and drafting prevention policy of relevant units. The artile is based on theoretical analysis, comparative method and induction method with relevant legal rules of other countries taken for comparison and reference with an attempt to establish the methods for the prevention of insurance fraud.With the analysis of this article,preventative works against insurance fraud may be achieved through practical work.In addition,the inapplicability of laws of the erroneous applicable of law may be avoided,and supplying the insurance fraud models to the investigators and police officers kept fraud offenders from the crimes and positively decreased the social and people’s damages.Its goal was to achieve the insurance companies to lower their running business risks. Keywords：insurance fraud，insurane companies，insurane claim，prevention of insurance fraud.
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Huang, Chih-Chin, and 黃智欽. "The Study on Personal Insurance Fraud." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/78125508519200524111.
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碩士淡江大學
保險學系保險經營碩士在職專班
103
Insurance fraud is the use of criminal methods to deceive insurance company in believing the occurrence of accident or lost, etc. for the intention of obtaining insurance claims. In earlier years because the occurrence of insurance fraud is not frequent, insurance companies and the general public did not pay much attention. Until recently years insurance fraud cases have increased drastically and repeatedly, thus catches public attentions. The continuous increases in insurance fraud cases have resulted in serious detrimental effects on insurance system and function. In present countries worldwide have legislation on insurance related fraud. The insurance law in Taiwan, although being through several major modifications, there has not yet any precise legislation regarding insurance fraud. With the continuous renewal of crime committing methods, fraud criminals also make use of the loophole of insurance law to commit crime. Thus, the study aims to explore motives of relative questions on insurance fraud. 表單編號：ATRX-Q03-001-FM031-01
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Sun, Teng-Min, and 孫騰敏. "The Research of Automobile Insurance Fraud." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/55315347381202672962.
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碩士淡江大學
保險學系保險經營碩士在職專班
96
Automobile insurance fraud is an issue that has fallen on deaf ears in Taiwan’s insurance market and there is no sufficient statistics for reference. In fact, the insurance fraud is common in our insurance industry. In life insurance market, the breach of disclosure and the double insurance dispute are often involved in moral hazard. Furthermore, the abnormal losses are also found in the non-life insurance industry, especially in the marine cargo insurance, the fire insurance and the automobile insurance. This situation which leads loss ratio much higher than normal can not be neglected. Insurance fraud makes high profit especially when the economy goes to depression. The rapid growth of Insurance Fraud could be a threat to an insurance company. Thus, this research, 「The Research of Automobile Insurance Fraud」 divides the automobile insurance fraud into two major parts, one is underwriting and the other is claim. There are 20 types of automobile fraud. The top 3 causes are applying for insurance after loss on underwriting side, making up an insurance loss and making fake insurance accidents on claim side. In order to identify, avoid and prevent the insurance fraud for insurance companies, consumers, government and other related parties, there are 4 conclusions in this research. The first is to understand and analyze the types of insurance fraud. The second is to enhance the professional training for insurance employees. The third is to conduct internal auditing. The last is to enforce legal guidance for cooperating shops and related parties. This research concludes two ideas that could be provided to the non-life insurance operation. The first idea is to make anti insurance fraud law into practice. The contents are to enforce the function of the insurance anti-fraud institute of the R.O.C., to establish the dynamic tracking system of the insurance fraud, to set up the special telephone line for informing the crime and rewards, to amend related laws, to set up anti insurance fraud policy unit, to establish the network among the insurance industry, the medical industry, and the police, to educate more on insurance. The second idea is more cooperation to the insurance industry, including professional anti-fraud training, anti insurance fraud reporting system, insurance product design enforcement, international market linking, and social responsibility.
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HUNG, CHIEN-WEN, and 洪健文. "Research of Insurance Crime-Focusing on National Health Insurance Fraud." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/892fuj.
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Wei, Ya-Hsun, and 魏雅珣. "A study on the Personal Insurance Fraud." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/bxmu25.
Full textAbstract:
碩士朝陽科技大學
保險金融管理系
105
The economic boom in Taiwan and the idea of having insurance is generally accepted bypublic. Nowadays insurance has become the necessity of commercial product.This is due to the increased number of insurance frauds which means the insurer or beneficiary would pay for the higher premium with the intent to obtain a fraudulent outcome by creating accidents on propose or even severe event, such as murder.This study explores how to reduce this situation by explaining the meaning, legal nature and national legislation of the insurance fraud, and then puts forward some suggestions on the existing Taiwan Insurance Law. Thisstudy is based on document analysis and case study method.It would analyse the root causes, such as, the reasons of why the events were taken place and features, from each case. The study is concerned the cases which are related to personal insurance fraud from 2011 to 2016 and the decisions were made by nationwide courtyards at the first trial. Suggestions and comments about how to avoid the fraud can be raised via reviewing and verifying the actual cases of insurance fraud. Therefore, we may reduce the number of insurance fraud. Finally, the study will list implementable suggestions based on the search result in order to reduce the incidence of insurance fraud in future.
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Liao, Yi-Wen, and 廖怡雯. "The Study on Personal Injury Insurance Fraud." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/c3d9a3.
Full textAbstract:
碩士淡江大學
保險學系保險經營碩士在職專班
106
This study aims to investigate the bodily injury fraud in insurance. As insurance fraud becomes more serious, the number of cases escalates and the modus operandi becomes organized and professionalized, causing many horrifying and serious criminal cases that shake social perceptions and overall social norms. Should insurance fraud be ineffectively stopped, apart from impacting the friendly structure of the insurance system, its effect on the financial market should not be overlooked. Through case studies, this study investigated and inferred new modus operandi in insurance fraud. Currently, many countries have made related laws to oversee insurance fraud and insurance-related crime. However, Taiwan still uses the criminal code to penalize insurance fraud and insurance-related crimes without making specific legislation. This study also disclosed the difficulties that claim adjusters face when handling insurance claims and analyzed the determination criteria of claims adjusters. Currently, the grievance rate of claims is the main requirement relating to the new products submitted for approval by insurers. Therefore, apart from affecting the image and business promotion, the quality of claims will affect the operations, financial safety, and sustainable development of insurers. In view of the lack of effective risk control measures of insurers, this study recommended mechanisms for improving insurance fraud prevention to prevent evil people and gangs from fearlessly committing insurance fraud by exploiting the loopholes in provisions and the self-monitoring of insurers. Therefore, it is necessary to enhance the optimization and technology innovation of the system for the risk control of insurance fraud in order to capture opportunist fraud offenders and for the reference of insurers.
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Lin, Tzu-Kuei, and 林子貴. "Research on Prevention of Auto Insurance Fraud." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/68180778244282444623.
Full textAbstract:
碩士崑山科技大學
企業管理研究所
104
The growing incidence of insurance fraud has become one of today's crime issues, which not only endanger the insurance market stability, but also affect the economic order of the country. How to make the prevention and control strategies effective has become the focus of the worldwide Insurance Supervisory. This study used case study, literature review, in-depth interview, and focus group interview from the industry, government, and academic experts, explored the following study topics: 1. Where profit was to be gained, no moral sense. 2. Insurance fraud crime had continuously regenerated, which would only have the transition of crime type or have the evolution of trick. Crime itself would not disappear. 3. Only the man who was close to the problem could solve it. 4. Stepping out with cautions, patience, and self-restraint to walk far. 5. Take precautions, get prepared before pouring rain. 6. Integrate every and each one in the industry by sharing information. And hence derived the following feasible tactical actions: 1. Set up the particular unit and assign the person in charge to deal with the relative issues. 2. Enhance internal education and on-job training to build up the curb of the prevention. 3. Firm internal audit and control to maintain the order. 4. Design the product with prudence and cautiousness and establish the database of fraud feature to systematically nose the trick out in the first place. 5. Integrate the notification mechanism and make well use of insurance fraud prevention platform. 6. Regularly share and exchange the information with other industry and expert to follow current trend. 7. Urge the government to pay much more attention to fraud crimes and to promote fraud prevention and control in people’s mind. 8. Prosecute fraud offenders with appropriate statute and clause to deter violators in futures. Hope this study will provide the insurance industry, following researcher, and authorities a well reference on prevention and control of insurance fraud.
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Garcia, Nuno Ricardo da Cruz. "Social Network Analysis for Insurance Fraud Detection." Master's thesis, 2015. http://hdl.handle.net/10400.6/5895.
Full textAbstract:
Fraud detection configures a very interesting problem yet to solve, particularly when related to
automobile insurance claims. In this research we address this challenge from a not so typical
"record" perspective of data, but rather from a network point of view, where relations between
entities involved in claims are explored to detect organized fraud structures.
First we propose a random data generator, able to generate graphs that resemble realistic patterns
evidenced on authentic scenarios, based on insurance authorities statistics and graph features
already described in the literature. We show how this graph copes with the requirements on
every single step, and how it can be adjustable to different locals.
Secondly, we propose a variation of Subelj approach [ŠFB11], and apply it to the generated graphs.
This approach explores the relations between entities, takes advantage of the power of social
network analysis metrics and statistical methods such as RIDIT scores and Principal Component
Analysis to score each connected component and Support Vector Machines to classify them either
fraudulent or honest.
The main contributions of this research is a new approach to generate data regarding automobile
insurance claims suitable for social network analysis, and a variation of an approach described
on the literature, proving thus not only benchmark results but also new insights regarding fraud
detection through graph-based algorithms.A detecção de fraude configura um desafio interessante, que não está totalmente resolvido particularmente no que respeita a fraude em seguros automóvel. A fraude no seguro automóvel representa várias centenas de milhões de euros de prejuízo para as companhias seguradoras na Europa, e consequentemente um aumento de preço das apólices cobrado ao consumidor final. A dimensão do mercado segurador e o impacto que a fraude tem nas companhias faz com que a tarefa de detecção de fraude possa transformada em vantagem competitiva, e assim se assuma como uma prioridade no sector. A fraude que provoca danos mais volumosos é a praticada por grupos organizados, que concebem esquemas e contornam o sistema de forma a sistematicamente repetir a actividade fraudulenta. Esta dissertação aborda o tema da detecção de fraude de uma perpectiva que não será a mais comum nos sistemas hoje em dia utilizados. Em vez de analisar dados de sinistros como números e estatísticas isoladas, tenta perceber as relações entre as entidades que participam nos sinistros e identificar estruturas suspeitas de entre um vasto conjunto de dados. O conjunto de dados necessário à análise que propomos tem características especiais, como por exemplo ser sensível a divulgação a terceiros por conter dados pessoais e ser normalmente propriedade das companhias de seguros ou de estruturas policiais. Por estes motivos, não existem conjuntos de dados públicos que permitam o desenvolvimento de uma investigação neste sentido. Para colmatar este facto, propomos um gerador de grafos aleatório capaz de produzir redes com padrões semelhantes àqueles que seria expectável encontrar em cenários reais. O gerador incorpora conhecimento descrito na literatura [ŠFB11] sobre características e padrões encontrados em conjuntos de dados relacionados com este tema. Além disso, especialistas de seguros da Deloitte, parceira no desenvolvimento desta dissertação, contribuiram com a sua experiência no campo para que o gerador pudesse representar fielmente a realidade. No que respeita à detecção de fraude, este trabalho propõe uma abordagem que inclui a classificação de componentes do grafo como fraudulentos ou honestos, através do uso do conhecido classificador SVM (Support Vector Machine). São feitas avaliações de performance com várias variações do método proposto e de parte do método que inspirou a abordagem usada, chamado PRIDIT. Uma das conclusões mais interessantes que estas experiências parecem sugerir é que nem sempre o uso do método PRIDIT garante o aumento de performance desejado. As contribuições deste trabalho centram-se no desenvlvimento de um gerador de grafos para o contexto de análise de fraude de seguros automóvel, e na avaliação e comparação do uso de SVM na classificação de componentes fraudulentos.
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Kuo, Tzu-Ping, and 郭姿萍. "A study on the Prevention of Insurance Fraud in Marine Insurance." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/10663448696547557711.
Full textAbstract:
碩士淡江大學
保險學系保險經營碩士班
95
“Insurance Fraud” has been an issue, since there exists the system of insurance. With the social events and relevant issues about insurance fraud keeping in aggravating recently. But the study about Insurance Fraud in Marine Insurance is too few. This paper collect those cases about Insurance Fraud in Marine Insurance. Therefore, this paper probed into “how to prevent Insurance Fraud in marine insurance from LAW and from RISK MANAGEMENT”. This paper would be analyzing the practical operation of an insurance company and trying to find out the feasibility of Insurance Fraud Prevention by using various kinds of risk management countermeasures. By which, this paper discovers the losses caused by insurance fraud could be prevented and/ or reduced. The followings are those risk management countermeasures studied and applied: A. The principle of “Risk Retention & Reduction” ; B. The principle of “Risk Avoidance or Hedging” ; C. The principle of “Risk Sharing & Diversification” ; D. The principle of “Risk Transference or Shift”.
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Chen, XuanYu, and 陳炫宇. "A Study on Insurance Fraud Prevention Rules-Focus on Contigency Insurance." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/59615894221240808475.
Full textAbstract:
碩士國立中正大學
法律學研究所
101
There can not be avoided the discussion of insurance fraud since insurance system began. Rather, the formulation and revision of the insurance laws and regulations usually greatly associated with insurance fraud. In the case of rapid social change, whether Taiwan Insurance Law is sufficient to guard against insurance fraud occurs or not. That is what we want to discuss. There are various insurance fraud types in Taiwan insurance contract, and according the insurance contract process, we can divided into two stages: pre-contract stge and post-contract stge. At pre-contract stge, insured may fraudulent misrepresent, and pass through incontest period which Insurance Law § 64(3) was regulated. Insured or beneficiary could get unjust benefit. At post-contract stge, the insured may take out several hospital medical insurances. This would increase the probability of insurance fraud occurrance. For another, when insurance accident occurred, the insured may falsely misrepresent about his loss. In this situation, Taiwan Insurance Law didn't stipulate the regulation about fraudulent claim. This showed that Taiwan Insurance Law couldn't response to social change, and there's necessary to re-examine it. Recently, the major countries started to revise its Insurance Code, and the revision was according to current social situation of its country. For example, United Kingdom enacted Consumer (Disclosure and Misrepresentation) Insurance Act at 2012, which was partially replaced Marine Insurance Act 1906.Before the act was enacted, Marine Insurance Act 1906 applicated to all type of insurance contract. And in 2006, German modified its Insurance Contract Law greatly. In 2008, Japan enacted the Insurance Code to replace the regulation in Commercial Code Insurance Chapter. This article will consult the latest legislation of U.K. and Japan, trying to introduce the the relevant legislative system to prevent the occurrence of insurance fraud.
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Chen, Yan-Chin, and 陳彥欽. "A Study on Insurance Anti-Fraud in Taiwan." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/06720020950872010103.
Full textAbstract:
碩士朝陽科技大學
保險金融管理系
102
As people’s risk awareness is heightened, the number of insurance purchasers is also increasing gradually. Although public acceptance of insurance is elevated and it is bringing a positive assistance to the local insurance industry, it is also causing problems with negative influence. In order to reap benefits, perpetrators create moral hazards and violate the principle of utmost good faith, which leads to a direct increase of operational risks for the insurers, and an indirect damage to the interests of all policyholders for risk sharing and equitable coverage of protection. The purpose of this study is to---- first, understand the nature of insurance fraud in Taiwan; and secondly, to analyze the characteristics of various forms of insurance fraud in Taiwan; and thirdly, to propose improvement measures for the deficiencies of insurance fraud prevention in Taiwan. Literature review and content analysis are adopted in this study. Through past literature we investigate how to improve the deficiencies of insurance fraud prevention in Taiwan. Then we conduct a content analysis of fraud cases compiled by Insurance Anti-Fraud Institute before we sum up the patterns, characteristics, and trends of insurance fraud in Taiwan. The study finds that the crime locations of insurance fraud are expanding from Taiwan to overseas, and there tend to be more and more organizational conspiracies. With cooperation from health care workers and policemen, it is even harder to prevent the crime. Since there are no regulations relating to insurance fraud prevention, the laws need to be amended as soon as possible, so that the penalties for the perpetrators can be strengthened. Furthermore, there should also be more insurance fraud prevention channels to deter people from trying to gain illicit insurance claims from fraudulent and wounding behaviors.
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Chung, Fong-Mi, and 鄭丰宓. "A Study on Criminal Liability of Insurance Fraud." Thesis, 1996. http://ndltd.ncl.edu.tw/handle/67407685813176123658.
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HSIEH, WAN-CHIAO, and 謝婉僑. "The Study on Factors of Life Insurance Fraud." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/24991762455114218165.
Full textAbstract:
碩士國立高雄第一科技大學
風險管理與保險系碩士班
105
In Taiwan, the concepts of purchasing insurance products today have become more open minded than before. Of greatest concern to insurers and public alike is the increasing spread of moral hazard when the ratio of prevalence and the ratio of having insurance coverage are expanding at high speed. Insurance fraud also flows from moral hazard, insurers or reinsuers increasingly consider the potential for fraud threats when considering underwriting and claims. The purpose of this study is to investigate the factors and effects of fraud modus operandi on gender, the location of the crime, criminal records, accomplices, age of convicts, number of insurance coverages, number of convicts, sum insured in life insurance. This empirical introduces a model of the factors of life insurance fraud using chi-square test and binary logistic regression. The results indicate that these variables showed that (1). Gender, number of convicts, sum insured were insignificantly different on effects of fraud modus operandi in life insurance. (2). The location of the crime, criminal records, and number of insurance coverages should be taken into account a binary logistic regression that the accuracy of forecasting muders model will reach more than 70 percent.