Journal articles: 'Investigation of insurance fraud'

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

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

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Purpose The purpose of this paper is to examine customers’ ethical attitudes (EA) and intentions toward two types of insurance frauds. This study proposes that the factors, such as fraud types (i.e. opportunistic and planned insurance fraud), moral intensity and fairness perception (FP), can affect the customers’ acceptance of the insurance frauds. Design/methodology/approach To test the research hypotheses of this study, Taiwanese insurance customers are invited in the empirical investigation, and a scenario-based questionnaire is used to collect the data. The hypotheses of this study are tested by using a partial least squares regression. Findings The results show that moral intensity constructs and FP significantly relate to the respondents’ acceptance of insurance frauds, while fraud types also have significant impacts on the respondents’ perceptions of moral intensity and fairness. Originality/value There is no research which has examined the relationships among fraud types, moral intensity, FP, demographic variables and customers’ EA and intentions toward insurance frauds. Understanding the relationships among these variables could provide implications for those involved in the practice of anti-fraud programs.

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von Bieberstein, Frauke, and Jörg Schiller. "Contract design and insurance fraud: an experimental investigation." Review of Managerial Science 12, no. 3 (February 10, 2017): 711–36. http://dx.doi.org/10.1007/s11846-017-0228-1.

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

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This article aims at outlining the role of the Insurance Guarantee Fund in preventing the phenomena related to insurance crime by means of the Integrated Platform for Identification and Verification of Insurance Crime.It also discusses the legal possibilities and limitations of sharing and exchanging data related to the operation of the anti-fraud platform. Being the only entity entitled to process motor insurance data centrally, the Fund plays a leading role in eliminating fraud in this field. At the same time, the article provides an analysis of legal issues related to the Fund's rights in the area of identification and verification of insurance fraud, and explores potential opportunities to improve the efficiency of insurance crime investigation resulting from the implementation of possible changes in law.

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Kim, Yongbum, and Miklos A. Vasarhelyi. "A Model to Detect Potentially Fraudulent/Abnormal Wires of an Insurance Company: An Unsupervised Rule-Based Approach." Journal of Emerging Technologies in Accounting 9, no. 1 (December 1, 2012): 95–110. http://dx.doi.org/10.2308/jeta-50411.

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

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Pustika Sukma, Dara, Adi Sulistiyono, and Widodo Tresno Novianto. "Fraud in Healthcare Service." SHS Web of Conferences 54 (2018): 03015. http://dx.doi.org/10.1051/shsconf/20185403015.

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In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare service. This research was taken place in several hospitals in Central Java Indonesia using non-doctrinal or empirical method on stakeholders related to national health insurance. The result of research showed that the substance of the ratification of Health Minister’s Regulation Number 36 of 2015 about Fraud Prevention in National Health Insurance in National Social Insurance System becomes the government’s attempt in suppressing fraud in healthcare service. In its structure, healthcare service occurs due to the pressure of enacted costing system, limited supervision, and justification in committing fraud and the imbalance between health service system and burden among clinicians, service provider not giving adequate incentive, inadequate medical equipment supply, system inefficiency, less transparency in health facilities, and cultural factor. Those who are responsible for the attempt of eradicating fraud such as Health Ministry, Regency/City Health Service, Hospital’s Board of Directors, Hospital Supervision Agency and Council, Social Insurance Administration Organization, professional organization, and Social Insurance participants should walk in the cycle starting from building awareness, reporting, detecting, investigating, sanction imposing, to building awareness.

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Munavalli, Sahana, and Sanjeevakumar M. Hatture. "Fraud Detection in Healthcare System using Symbolic Data Analysis." International Journal of Innovative Technology and Exploring Engineering 10, no. 9 (July 30, 2021): 1–7. http://dx.doi.org/10.35940/ijitee.h9269.0710921.

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In the era of digitization the frauds are found in all categories of health insurance. It is finished next to deliberate trickiness or distortion for acquiring some pitiful advantage in the form of health expenditures. Bigdata analysis can be utilized to recognize fraud in large sets of insurance claim data. In light of a couple of cases that are known or suspected to be false, the anomaly detection technique computes the closeness of each record to be fake by investigating the previous insurance claims. The investigators would then be able to have a nearer examination for the cases that have been set apart by data mining programming. One of the issues is the abuse of the medical insurance systems. Manual detection of frauds in the healthcare industry is strenuous work. Fraud and Abuse in the Health care system have become a significant concern and that too inside health insurance organizations, from the most recent couple of years because of the expanding misfortunes in incomes, handling medical claims have become a debilitating manual assignment, which is done by a couple of clinical specialists who have the duty of endorsing, adjusting, or dismissing the appropriations mentioned inside a restricted period from their gathering. Standard data mining techniques at this point do not sufficiently address the intricacy of the world. In this way, utilizing Symbolic Data Analysis is another sort of data analysis that permits us to address the intricacy of the real world and to recognize misrepresentation in the dataset.

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Chung Woong. "Analysis on Workload of Insurance Fraud Investigation Team in the Police." Journal of Korean Public Police and Security Studies 12, no. 3 (November 2015): 143–65. http://dx.doi.org/10.25023/kapsa.12.3.201511.143.

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

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The increasing rate of fraud occurrence and poor profitability rate in the listed Deposit Money Banks (DMBs) in Nigeria calls for a research investigation. To unravel the likely connection between fraud and profitability, this study has examined the effect of fraud on the profitability of listed DMBs in Nigeria. To achieve this objective, the study adopted a correlational research design and utilised secondary data extracted from the Nigerian Deposit Insurance Commission (NDIC) and published financial statements of the DMBs. The study focused on 14 listed DMBs for a six-year period (2012-2017). Panel multiple regression technique was used to estimate the model of the study. The findings showed that fraud (proxied by actual loss from fraud and staff involvement in fraud) has a negative and significant effect on profitability (proxied by return on asset) of listed DMBs in Nigeria. In line with the findings, this study has recommended that listed DMBs should establish fraud detection mechanisms which will entail the setting up of an efficient, reliable and functioning fraud detection unit to monitor transactions that may be susceptible to fraud.

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Sooksripaisarnkit, Poomintr. "Marine insurance – collateral lies: when lies are not fraud." Maritime Business Review 2, no. 1 (March 15, 2017): 52–56. http://dx.doi.org/10.1108/mabr-09-2016-0020.

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

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Kaplan, Steven E., Danny Lanier, Kelly R. Pope, and Janet A. Samuels. "External Investigators' Follow-Up Intentions When Whistleblowers Report Healthcare Fraud: The Effects of Report Anonymity and Previous Confrontation." Behavioral Research in Accounting 32, no. 2 (July 15, 2020): 91–101. http://dx.doi.org/10.2308/bria-19-042.

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ABSTRACT Whistleblowing reports, if properly investigated, facilitate the early detection of fraud. Although critical, investigation-related decisions represent a relatively underexplored component of the whistleblowing process. Investigators are responsible for initially deciding whether to follow-up on reports alleging fraud. We report the results of an experimental study examining the follow-up intentions of highly experienced healthcare investigators. Participants, in the role of an insurance investigator, are asked to review a whistleblowing report alleging billing fraud occurring at a medical provider. Thus, participants are serving as external investigators. In a between-participant design, we manipulate the report type and whether the caller previously confronted the wrongdoer. We find that compared to an anonymous report, a non-anonymous report is perceived as more credible and follow-up intentions stronger. We also find that perceived credibility fully mediates the relationship between report type and follow-up intentions. Previous confrontation is not significantly associated with either perceived credibility or follow-up intentions. Data Availability: Data are available upon request.

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Ivasiuk, K. S. "The use of special knowledge in the investigation of fraud in the field of property insurance." State and Regions. Series: Law, no. 2 (2019): 130–36. http://dx.doi.org/10.32840/1813-338x-2019-2-22.

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Cook, Jack S., and M. Pamela Neely. "Building Intelligent Systems for Paying Healthcare Providers and Using Social Media to Detect Fraudulent Claims." International Journal of Organizational and Collective Intelligence 7, no. 2 (April 2017): 13–33. http://dx.doi.org/10.4018/ijoci.2017040102.

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Using an interpretive case study approach, this paper describes the data quality problems in a regional health insurance (RHI) company. Within this company, two interpretive cases examine different processes of the healthcare supply chain and their integration with a business intelligence system. Specifically, the first case examines RHI's provider enrollment and credentialing process, and the second case examines the processes within the special investigations unit (SIU) for investigating and detecting fraud. The second case examines DIQ issues and how social media can be used to acquire evidence to support a fraud case. In addition, the second case utilized lean six sigma to streamline internal processes. A data and information quality (DIQ) assessment of these processes demonstrates how a framework, referred to as PGOT, can identify improvement opportunities within any information intensive environment. This paper provides recommendations for DIQ and social media best practices, and illustrates these best practices within this real-world context of healthcare.

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Krambia Kapardis, Maria, and Konstantinos Papastergiou. "Fraud victimization in Greece: room for improvement in prevention and detection." Journal of Financial Crime 23, no. 2 (May 3, 2016): 481–500. http://dx.doi.org/10.1108/jfc-02-2015-0010.

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Purpose The purpose of this paper is to investigate fraud victimisation of Greek companies during the financial crisis years. Moreover, the paper seeks to encourage the implementation of proactive and reactive measures in an effort to minimize fraud victimisation. Design/methodology/approach Drawing on an extensive literature review and utilising a questionnaire administered by Krambia-Kapardis and Zopiatis (2010), auditors and management of companies who had fallen victim to fraud provided information on the typology of fraud and on proactive and reactive measures taken after a fraud incident had been reported to them. Both descriptive and inferential statistics were utilized to analyze the collected data and address the postulated research questions. Findings The survey has found that no industry or size of company is immune from fraud, with bigger companies and small- and medium-sized enterprises (SMEs) falling victim to industrial espionage and theft of cash and counterfeit, respectively. The banking and insurance sector appeared to be affected mainly by money laundering. Management fraud was mainly in the form of window dressing, whilst employee fraud involved predominately theft of cash and assets. Loss of reputation emerged as the main concern for the victim, and it had a determining impact on deciding not to report cases to the police. Research limitations/implications Because of the sensitive topic being investigated and despite having assured the respondents that their anonymity would be guaranteed, the respondents were hesitant in responding. Thus, the response rate was 16.4 per cent, slightly lower than a similar study carried out in Cyprus (Krambia-Kapardis and Zopiatis 2010). The findings, however, are considered to be reliable, given the fact that the respondents were individuals well versed with the topic under investigation and in a position to know if their company had fallen victim to fraud. Practical implications The findings have practical relevance to both industry stakeholders and academics who wish to further explore fraud victimization in the Greek business environment. Given that the financial crisis in Greece is continuing, fraud risk assessment ought to concentrate in the area of cash, and preventative measures need to be considered by the regulators and the victims. Originality/value Whilst fraud victimisation studies are becoming popular by the Big 4 accounting firms, there is no fraud victimisation study concentrating on the typology of fraud in Greece. With this survey, it will be possible to draw conclusions and make suggestions to the accounting profession on how to combat fraud, at a time, when the economic crisis is persisting and fraud is expected to escalate.

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Tseng, Lu-Ming, Yue-Min Kang, and Chi-Erh Chung. "Understanding the roles of loss-premium comparisons and insurance coverage in customer acceptance of insurance claim frauds." Journal of Financial Crime 21, no. 3 (July 1, 2014): 321–35. http://dx.doi.org/10.1108/jfc-02-2013-0009.

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Purpose – The purpose of this paper is to examine the impacts of loss-premium comparisons (loss-premium comparison refers to the amount of an actual loss compared to the premium level) and insurance coverage on customer acceptance of insurance claim frauds, based on Adams’ equity theory. Customer perceptions of insurance frauds have been studied in recent years. Design/methodology/approach – A questionnaire was used as an instrument in the research. The hypotheses were tested using a 3 loss-premium comparisons (the actual loss amount was lower than, or equal to or higher than the annual premium) × 2 insurance coverage (the loss is covered or not covered by the insurance policy) experimental design in a claim application context. Findings – The results showed that loss-premium comparisons and insurance coverage significantly affect the final claim amounts. According to the results, age and education may relate to customer acceptance of insurance claim frauds. Originality/value – This study proposed a first empirical investigation into the relationship between loss-premium comparisons and customer ethical decision making in the customer frauds. Insurance coverage is also specifically considered in the study.

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Button, Mark, and Graham Brooks. "From ‘shallow’ to ‘deep’ policing: ‘crash-for-cash’ insurance fraud investigation in England and Wales and the need for greater regulation." Policing and Society 26, no. 2 (October 8, 2014): 210–29. http://dx.doi.org/10.1080/10439463.2014.942847.

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Van Outrive, Lode. "Des tâches policières privatisées à une police grise : quatre recherches belges en la matière." Criminologie 31, no. 2 (September 1, 2005): 7–30. http://dx.doi.org/10.7202/017416ar.

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This article summarizes the combined results of four branches of research concerning the privatization of policing tasks and the interaction between private agencies and police conducted between 1988 and 1997 in Belgium. The first segment focused on private detectives. A second research segment converged on the evolution of specialized investigations in insurance fraud. A third branch was aimed at the lack of legal protection available to citizens that had been subject to private investigations. The final segment consisted of an analysis of " grey policing". All research segments developed from a certain number of hypothesis and were based exclusively on qualitative research methods. Results from each segment have been assessed alongside established theories.

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Heard, Bridgette, Kendall Howard, Laura M. Miller, and Pankaj Kumar. "Creation and implementation of a corporate compliance program (CCP): The Illinois CancerCare (ILCC) experience." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 256. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.256.

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256 Background: In 2000, Office of Inspector General (OIG) provided guidance for physician practices in the adoption of corporate compliance program (CCP). The notice provided a basic outline that would allow organizations to detect, prevent and possibly report potential fraud and abuse as it relates to federal health care payers. Insurance payers, e.g., United, Healthcare, and Humana, are also requiring organizations to institute CCP for reimbursement. As health care reform evolves there is will be a greater need for an alliance between providers and payers as each are increasingly held accountable for their actions related to ethical behavior in documentation, billing and coding, HIPAA, improper inducements, kickbacks, financial conflicts of interest, in addition to other areas. Methods: The Illinois CancerCare (ILCC) is one of the largest private oncology practice in Midwest. We implemented the components outlined by OIG by completing the following tasks: identifying and empowering a compliance officer; identifying high-risk areas; developing policies and standards for major processes that might lead to fraud, waste, or abuse; developing a training program for all physicians, NPs, and employees; creating and implementing an auditing and monitoring program; developing investigation and remediation standards; and establishing committees for oversight. Results: The entire process took 18 months to be fully functional. We have developed a plan that is completely complaint and meets all the criteria as required and our personnel have been trained. Conclusions: In future most large practices in the United States will likely be required to have a CCP. It is complicated and includes multistep processes. In the end, implementing a CCP allows organizations to show their desire to be a quality organization with internal monitors to ensure they are participating in federal health care programs using ethical standards.

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Domínguez-Muñoz, Antonio. "Scientific basis of the System for Analysis of Validity in Evaluation: The SAVE Metaprotocol." South Florida Journal of Development 2, no. 2 (June 28, 2021): 3679–84. http://dx.doi.org/10.46932/sfjdv2n2-203.

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There are multiple situations, often related to the administrative or judicial field, in which it is necessary to use a healthy skepticism, to question the validity of an assertion, appealing to the evidence that can prove or disprove it. (Shermer, 2008). From a child custody issue to facing a harsh criminal conviction, to applying for a disability pension or obtaining an indemnity in an insurance context; in all of them, there is the opportunity to use deception for one's own benefit, harming a third party, through fraud. As we know, opportunity, together with prior motivation or incentive and subsequent justification, constitute the classic fraud triangle proposed by Cressey (1961). This questioning of the validity of the case understood as its accuracy or correspondence with what it pretends to be and independently of its various types, is only possible from a method of analysis based on scientific evidence that benefits from using a system ordered by rules for the investigation - which we know as a protocol (Amezcua, 2000) - as well as a multiple approaches (Campbell and Fiske, 1959) that is proportionate to a conception of the detection and demonstration of deception from the approach of complexity (Cardozo, 2011). If, in addition, such a system was sufficiently flexible to be useful in the daily practice of the various fields in which it may be necessary to use it, it could represent a significant advance in this area. These, together with those of Behavior Analysis in Ethology, Criminology, and Psychology, are the initial theoretical bases on which the System of Analysis of Validity in Evaluation (SAVE) is designed, establishing four phases in two domains of multiple and orderly but flexible application, to scientifically question the validity of a case and provide it with consistency and even legal value when appropriate. Although SAVE was born in a clinical context (Domínguez-Muñoz et al., 2014) its main area of knowledge is the study of lying and deception, an area in which there is a large bibliography, somewhat dispersed among various disciplines, which must be incorporated as a source of academic knowledge for its use in the applied field (Domínguez-Muñoz et al., 2017).

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CLARKE, MICHAEL. "INSURANCE FRAUD." British Journal of Criminology 29, no. 1 (1989): 1–20. http://dx.doi.org/10.1093/oxfordjournals.bjc.a047785.

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Derrig, Richard A. "Insurance Fraud." Journal of Risk & Insurance 69, no. 3 (September 2002): 271–87. http://dx.doi.org/10.1111/1539-6975.00026.

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Dixon, Mike. "Insurance Fraud." Journal of Financial Crime 3, no. 2 (March 1995): 168–69. http://dx.doi.org/10.1108/eb025700.

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Niemi, Hannu. "Insurance fraud." European Journal on Criminal Policy and Research 3, no. 1 (March 1995): 48–71. http://dx.doi.org/10.1007/bf02243132.

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ARAGA, Abdullahi Shehu, and Sufian Babatunde JELILI. "FRAUDS AND FORGERIES ON THE PERFORMANCE OF THE NIGERIAN BANKING INDUSTRY." LASU Journal of Employment Relations & Human Resource Management 1, no. 1 (December 1, 2018): 61–68. http://dx.doi.org/10.36108/ljerhrm/8102.01.0180.

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This study focused on Frauds and Forgeries and the Performance of the Nigerian Banking Industry. The research method adopted is the Ex-Post-facto method. Data were sourced from the various publications of the CBN Statistical Bulletins and the Nigeria Deposit Insurance Corporation (NDIC)Publications. These data were analyzed using regression analysis. The period for this study covered between 1994 and 2016. The study established that: the number of reported frauds and forgeries cases has a significant positive on bank performance in Nigeria, the total amount involved in frauds has negative sign and is a significant determinant of the level of bank performance in Nigeria in the period under investigation and the actual losses to frauds does not have significant impact on bank performance in Nigeria. Based on the above findings, the following recommendations are proffered. Accurate and timely reportage of cases of frauds and forgeries activities in the banking sector should be vigorously pursued by bank’s management and regulatory body in Nigeria. This will in no small measure help to reduce and scare from fraudsters and prospective fraudsters from engaging in bank’s fraudulent activities. Finally, in view of the observed inverse relationship between frauds and the performance of the Nigerian banking industry, deliberate efforts with respect to appropriate policies and programs should be made by the respective regulatory authorities in the country to help curtail the incidences of bank related frauds and forgeries.

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Boyer, M. Martin. "Insurance Taxation and Insurance Fraud." Journal of Public Economic Theory 2, no. 1 (January 2000): 101–34. http://dx.doi.org/10.1111/1097-3923.00031.

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Dixon, Mike. "Insurance Fraud: US Initiatives." Journal of Financial Crime 1, no. 4 (January 1994): 328–36. http://dx.doi.org/10.1108/eb025631.

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Bacher, Jean-Luc. "Insurance, fraud and justice." European Journal on Criminal Policy and Research 3, no. 1 (March 1995): 84–92. http://dx.doi.org/10.1007/bf02243134.

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Ефремов, Андрей, and Andrey Efremov. "THE DEVELOPMENT OF THE USA LEGISLATION ON THE FIGHT AGAINST TERRORISM AFTER 11 SEPTEMBER 2001." Journal of Foreign Legislation and Comparative Law 3, no. 3 (July 10, 2017): 86–92. http://dx.doi.org/10.12737/article_593fc343c391e2.71878517.

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The article is devoted to development of the USA legislation on the fight against terrorism. The author considered the objectives and tasks of the state in a particular historical period; analyzed the laws passed by the USA Congress aimed at combating home and international terrorism; identifies the main directions of the state policy of the USA in the field of counter-terrorism. The article covers the events after 11 September 2001 to the present. The author gives a brief overview of the events of 11 September 2001, discusses the Patriot Act and other laws, aimed at combating terrorism. The Patriot Act allows the Federal Bureau of Investigation to intercept telephone, verbally and electronic communications relating to terrorism, computer and mail fraud; introduces special measures to combat money-laundering; expands immigration rules, in particular, mandatory requirement of detention of persons suspected of terrorism appeared; reveals the procedure of multilateral cooperation to combat terrorism, strengthening measures to investigate terrorist crimes; established rewards for information on terrorism; introduces the procedure of identification of DNA of persons charged for committing terrorist crimes or any violent crime; introduced the concept of domestic terrorism and Federal crimes of terrorism, the prohibition on harboring terrorists and material support; there is a new crime — terrorist and other acts of violence against public transportation systems. The law abolished for the statute of limitations for crimes of terrorist orientation. In 2002 5 laws wer adopted: “Homeland Security Act of 2002”, “Maritime Transportation Security Act of 2002”, “Aviation and Transportation Security Act“, “Public Health Security and Bioterrorism Preparedness and Response Act of 2002”, “Terrorism Risk Insurance Act of 2002”. The Palestinian Anti-Terrorism Act was adopted in 2006. This law restricted the financial assistance to the Palestinian national authority; Haqqani Network Terrorist Designation Act of 2012 included the Haqqani Network in the list of international terrorist organizations; the political act of refusal of admission to the United States representative to the United Nations, because he was accused of the occupation of the espionage or terrorist activities against the United States and poses a threat to the national security interests of the United States.

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Bera, Anna. "Innovation in counteracting insurance fraud." European Journal of Service Management 28 (2018): 15–21. http://dx.doi.org/10.18276/ejsm.2018.28/1-02.

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CLARKE, MICHAEL. "THE CONTROL OF INSURANCE FRAUD." British Journal of Criminology 30, no. 1 (1990): 1–23. http://dx.doi.org/10.1093/oxfordjournals.bjc.a047963.

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Gavriletea, Marius, and Dana Cimpean. "INSURANCE FRAUD � CASE OF ROMANIA." International Journal of Business Research 17, no. 2 (June 1, 2017): 77–86. http://dx.doi.org/10.18374/ijbr-17-2.6.

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Farber, N. J. "Confidentiality and health insurance fraud." Archives of Internal Medicine 157, no. 5 (March 10, 1997): 501–4. http://dx.doi.org/10.1001/archinte.157.5.501.

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Farber, eil J. "Confidentiality and Health Insurance Fraud." Archives of Internal Medicine 157, no. 5 (March 10, 1997): 501. http://dx.doi.org/10.1001/archinte.1997.00440260035007.

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Viaene, Stijn, and Guido Dedene. "Insurance Fraud: Issues and Challenges." Geneva Papers on Risk and Insurance - Issues and Practice 29, no. 2 (April 2004): 313–33. http://dx.doi.org/10.1111/j.1468-0440.2004.00290.x.

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Menkus, Belden. "Health insurance fraud claims settled." Computer Fraud & Security Bulletin 1993, no. 4 (April 1993): 4. http://dx.doi.org/10.1016/0142-0496(93)90283-3.

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Litton, Roger. "Moral hazard and insurance fraud." European Journal on Criminal Policy and Research 3, no. 1 (March 1995): 30–47. http://dx.doi.org/10.1007/bf02243131.

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Moon, Jun Seob, and Gyu Dong Kim. "Actual Condition and Cause of Insurance Fraud: Focused on Case of Fraudulent Insurance Fraud." Korean Association of Police Science Review 20, no. 4 (August 31, 2018): 25–48. http://dx.doi.org/10.24055/kaps.20.4.2.

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Akomea-Frimpong, Isaac, Charles Andoh, and Eric Dei Ofosu-Hene. "Causes, effects and deterrence of insurance fraud: evidence from Ghana." Journal of Financial Crime 23, no. 4 (October 3, 2016): 678–99. http://dx.doi.org/10.1108/jfc-11-2015-0062.

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Purpose This paper aims to measure the extent of effects of insurance fraud on the financial performance of insurance companies in Ghana. It also examines the causes and stringent measures that can be used to fight against insurance fraud. Design/methodology/approach Primary and secondary data obtained from 39 insurers in Ghana are used in this paper. A multiple regression model is used to determine the relationship between financial performance and insurance fraud variables. Findings The results from the model indicate that statistically insurance fraud has a significant negative effect on the annual return on assets (financial performance) of insurers in Ghana. Also, weak internal controls, poor remuneration of employees, falsified documents, deliberate acts of policyholders to profit from the insurance contract and inadequate training for independent brokers are found to be the major causes of insurance fraud in Ghana. To deter insurance fraud, effective internal fraud policy, rigorous assessment of insurance policies and claims, adequate training for independent brokers on insurance fraud and modern information technology tools are paramount in fighting this menace in Ghana. Research limitations/implications These findings are to have substantial impact on the techniques insurance companies will develop to fight insurance fraud and the policies that will be developed by governments and national insurance regulatory bodies to fight this menace. Originality/value The main value of this paper is the determination of the key variables that constitute insurance fraud and their impacts on the annual financial performance of insurance companies in Ghana.

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Zourrig, Haithem, Jeongsoo Park, Kamel El Hedhli, and Mengxia Zhang. "The effect of cultural tightness–looseness on fraud perception in insurance services." International Journal of Quality and Service Sciences 10, no. 2 (June 18, 2018): 138–48. http://dx.doi.org/10.1108/ijqss-02-2017-0016.

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Purpose The purpose of this paper is to investigate how cultural tightness may influence consumers’ attitudes toward insurance services and occurrence of insurance fraud. Design/methodology/approach Drawing on Gelfand et al.’s (2011) theory of tight and loose cultures, the authors theorize that perceived wrongness of insurance fraud, fraud occurrence and perceived risk of being caught depend on the cultural tightness. Using field data from a global European social survey (ESS), the authors investigate these differences across two fairly different European countries – Norway (i.e. tight culture) and Ukraine (i.e. loose culture). Findings Consumers from tight culture report less tolerance for insurance fraud (inflating insurance claim) are less likely to commit an insurance fraud, and they perceive higher level of risk of being caught than their counterparts from loose culture (Ukraine). Practical implications Understanding cultural variability in attitude toward insurance fraud, the occurrence of insurance fraud and the sensitivity to the risk of being caught could enrich the authors knowledge about how to prevent insurance fraud. Social implications Consumer protection agencies, consumer educators and policymakers could all benefit from understanding cultural variability in attitude toward fraud. This will potentially help to design effective learning and education programs to sensitize customers to the illegal and unethical aspects of fraudulent behaviors. Originality/value Insurance fraud is a universal issue and exists in many European countries, yet no previous work has investigated the effect of cultural tightness–looseness on fraud perception.

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SCHNEIDER, MARY ELLEN. "Insurance Fraud Scheme Investigated in N.Y." Clinical Psychiatry News 36, no. 3 (March 2008): 78. http://dx.doi.org/10.1016/s0270-6644(08)70208-x.

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Fuller, David L., B. Ravikumar, and Yuzhe Zhang. "Unemployment Insurance Fraud and Optimal Monitoring." American Economic Journal: Macroeconomics 7, no. 2 (April 1, 2015): 249–90. http://dx.doi.org/10.1257/mac.20130255.

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An important incentive problem for the design of unemployment insurance is the fraudulent collection of unemployment benefits by workers who are gainfully employed. We show how to efficiently use a combination of tax/subsidy and monitoring to prevent such fraud. The optimal policy monitors the unemployed at fixed intervals. Employment tax is nonmonotonic: it increases between verifications but decreases after a verification. Unemployment benefits are relatively flat between verifications but decrease sharply after a verification. Our quantitative analysis suggests that the optimal monitoring cost is 60 percent of the cost in the current US system. (JEL D82, H24, J64, J65)

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Moreno, Ignacio, Francisco J. Vazquez, and Richard Watt. "Can Bonus-Malus Allieviate Insurance Fraud?" Journal of Risk Insurance 73, no. 1 (March 2006): 123–51. http://dx.doi.org/10.1111/j.1539-6975.2006.00168.x.

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Doig, Alan, Bryn Jones, and Ben Wait. "The Insurance Industry Response to Fraud." Security Journal 12, no. 3 (July 1999): 19–30. http://dx.doi.org/10.1057/palgrave.sj.8340027.

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Ruvin, O., and V. Matveiv. "EXPERT STUDY TO DETERMINE THE MARKET VALUE OF WATERCRAFTS AND ITS COMPONENTS IN FORENSIC PRACTICE." Criminalistics and Forensics, no. 65 (May 18, 2020): 585–93. http://dx.doi.org/10.33994/kndise.2020.65.58.

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The article is devoted to the problems of one of the types of forensic transport and commodity examination on the value of water transport, namely, watercraft. The fast pace of saturation of the consumer market of Ukraine with such means occurs both due to domestic official certified manufacturers, as well as due to amateur activities, illegal production, smuggling of imported shipping means into the customs territory of Ukraine. The expansion of their assortment leads to the fact that they become the objects of forensic examination. Processes such as the transition of society to market economic, the privatization of state and communal property, the development of insurance activities, changes in legislation, force investigators, judges, bailiffs to raise issues related to the right of ownership. And the use of water transport for forensic examination with cases of falsification, fraud, incompetence of certain officials, determination of the actual market value of these objects during shifts of the owner (ownership distribution), imperfection of our legislation and so on. All of the above emphasizes once again the complexity research of water transport objects, especially when they are conducted only on the case and up on the last date. Commodity examination and research to determine the market value of water transport cannot exist separately, without technical research, and is quite a challenge for the expert. This is due to the following factors: the lack of valuation methodologies for both large and small vessels as a whole, limited price information in open sources. Expert practice regarding the assessment of water transport indicates that such examinations and all areas require a broad development and scientific and methodological approach, since the process of researching water transport is quite complex, diverse and specific, given that, recently, pre-trial investigation authorities, courts are increasingly turning to the Kyiv Scientific Research Institute of Forensic Expertise to resolve issues. At present, a large number of different research have been conducted at the Kyiv Scientific Research Institute of Forensic Expertise, many examples have been collected, and key points of examination of water transport have been identified. In the light of the above experience, to ensure the scientific validity of the answers to the questions put to the experts, work is underway to develop a methodology for expert value of water transport.

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Kang, Young-Ki. "A Study on the Insurance fraud and the need for fraud invalid provision of insurance contracts." Korea Financial Law Association 13, no. 1 (April 30, 2016): 123–57. http://dx.doi.org/10.15692/kjfl.13.1.4.

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Dehghanpour, Ali, and Zeinab Rezvani. "The profile of unethical insurance customers: a European perspective." International Journal of Bank Marketing 33, no. 3 (May 18, 2015): 298–315. http://dx.doi.org/10.1108/ijbm-12-2013-0143.

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Purpose – Although perceived as a wrong act, insurance fraud is a prevalent phenomenon. The purpose of this paper is to understand the psychological factors that lead to reporting an exaggerated/false insurance claim would enable insurance companies and policy makers to devise better preventive policies. Design/methodology/approach – Utilizing data-driven clustering techniques on psychological and demographic measures from 985 insurance customers in Europe, this study outlines profiles of segments of customers as it relates to dishonesty in dealing with insurance companies. The segmentation criteria include attitude toward insurance fraud, perceived probability of punishment, basic human values and morals, religiosity, life satisfaction and demographic characteristics. Findings – Results reveal the existence of four market segments. The segments include non-conservatives (sensitive to both perception of wrong behavior and the monetary payoff for a fraudulent claim), self-protectionists (sensitive to the probability of being caught), hedonists (sensitive to the personal pleasure and monetary payoffs for insurance fraud) and socially focused individuals (sensitive to social norms regarding admitting to having committed insurance fraud). Among the demographic variables, only education and among psychological variables, universalism, hedonism, security, conformity, tradition, benevolence, moral philosophy, religiosity, perceived probability of punishment and attitude toward insurance fraud were significantly different among the four identified segments. Practical implications – Specific policies are proposed in order to prevent insurance fraud, tailored to the specific profile of each segment. Originality/value – Using a psychological perspective and a data-driven methodology, this study identifies four heterogeneous segments of unethical insurance customers with dissimilar values, attitudes toward fraud and perception of punishment probability.

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Pathmananathan, P. Ravindran, and Khairi Aseh. "Identifying Predictors of Perceived Claims of Insurance Fraudulance." Archives of Business Research 9, no. 6 (June 27, 2021): 68–76. http://dx.doi.org/10.14738/abr.96.10343.

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Insurance fraud affects nearly every industry in the world, costing companies and others that pay insurance premiums billions of dollars per year. Insurance fraud can be found in almost any area of business where liability insurance is carried and intended to protect consumers; illegal activity can be detected in almost any field of business where liability insurance is carried and intended to protect consumers. The aim of this study is to study the predictor/s of anti-insurance fraud among non-insurer companies in Vietnam. This study was conducted using a questionnaire that was completed by 51employees who are currently working in the 11 non-life insurance company in Vietnam. It can be concluded that there exists a significant relationship between all the three independent variables which are namely claim procedure as well as business operation management and the dependent variable which is anti fraud procedure.

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Shawyer, Andie, and Dave Walsh. "Fraud and Peace: Investigative Interviewing and Fraud Investigation." Crime Prevention and Community Safety 9, no. 2 (April 2007): 102–17. http://dx.doi.org/10.1057/palgrave.cpcs.8150035.

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Gasanov, Amid. "Criminal liability for insurance fraud in the Romano-German legal system." E3S Web of Conferences 164 (2020): 11032. http://dx.doi.org/10.1051/e3sconf/202016411032.

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The article is devoted to the issue of fighting insurance fraud in the states of Romano-German legal system. The aim of the work is to study the experience of the states of Romano-German legal system in field of fighting insurance fraud. For the analysis of foreign criminal law, the comparative legal method was used. In addition, study was carried out using formal logical, dialectical method of cognition of social and legal phenomena, as well as methods of induction and deduction. Based on the study of legislative separate states, the author notes a number of specific features of development of this legislation. In particular, it is indicated that in relation to the issue of establishing liability for insurance fraud in the criminal law of the European states of the Romano-German legal system, there are three main approaches: liability comes within the framework of general rules on fraud (France); liability is partially established in the framework of special criminal law on liability for insurance fraud, partly such liability arises in accordance with general criminal law in the field of fraud (for example, Germany, Austria); liability for insurance fraud is provided in the framework of special criminal law on liability in the area in question (for example, Holland, Italy) and a number of others.

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Holder, Angela R. "Studying Fraud: Is Insurance Claim Information Confidential?" IRB: Ethics and Human Research 12, no. 4 (July 1990): 4. http://dx.doi.org/10.2307/3563561.

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Journal articles on the topic 'Investigation of insurance fraud'

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