Search results for: insurance fraud

Authors: Pavel Pešout, Miroslav Andrle

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Frauds in insurance industry are one of the major sources of operational risk of insurance companies and constitute a significant portion of their losses. Every reasonable company on the market aims for improving their processes of uncovering frauds and invests their resources to reduce them. This article is addressing fraud management area from the view of extension of existing Business Intelligence solution. We describe the frame of such solution and would like to share with readers all benefits brought to insurance companies by adopting this approach in their fight against insurance frauds.

Keywords: business intelligence, insurance fraud, fraudmanagement

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Authors: Roshan Jelal, Charles Mbohwa

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In today’s world, internal fraud remains one of the most challenging problems within companies worldwide and despite investment in controls and attention given to the problem, the instances of internal fraud has not abated. To the contrary it appears that internal fraud is on the rise especially in the wake of the economic downturn.

Leadership within companies believes that the more sophisticated the controls employed the less likely it would be for employees to pilfer. This is a very antiquated view as investment in controls may not be enough to curtail internal fraud; however, ensuring that a company drives the correct culture and behavior within the organization is likely to yield desired results.

This research aims to understand how creating a strong ethical culture and embedding the principle of good corporate governance impacts on levels of internal fraud with an organization (a South African Bank).

Keywords: Internal Fraud, Corporate Governance, Ethics, South African Reserve Bank, The King Code.

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Authors: Raziah Bi Mohamed Sadique, Jamal Roudaki, Murray B. Clark, Norhayati Alias

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Economic crime (i.e. corporate fraud) has a significant impact on business. This study analyzes the fraud cases reported by the Malaysian Securities Commission. Frauds involving market manipulation and/or illegal share trading are the most common types of fraud reported over the 6 years analyzed. The highest number of frauds reported involved investment and fund holding companies. Alarmingly the results indicate quite a high number of frauds cases are committed by management. The higher number of Chinese perpetrators may be due to fact that they are the dominant group in Malaysian business. The result also shows that more than half of companies involved with fraud are privately held companies in the investment/fund/finance sector. The results of this study highlight general characteristic of perpetrators (person and company) that commit fraud which could help the regulators in their monitoring and enforcement activities. To investors, this would help in analyzing their business investment or portfolio risk.

Keywords: Corporate fraud, economic crime, fraudcharacteristic, perpetrators

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Authors: D. Jakovčević, M. Mihelja Žaja

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This paper provides an analysis of the insurance cycle in the Republic of Croatia and whether they are affected by catastrophic losses on a global level. In general, it is considered that insurance cycles are particularly pronounced in periods of financial crisis, but are also affected by the growing number of catastrophic losses. They cause the change of insurance cycle and premium growth and intensification and narrowing of the coverage conditions, so these variables move in the same direction and these phenomena point to a new cycle. The main goal of this paper is to determine the existence of insurance cycle in the Republic of Croatia and investigate whether catastrophic losses have an influence on insurance cycles.

Keywords: Catastrophic loss, insurance cycle, premium, Republic of Croatia.

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Authors: D. Jakovčević, M. Mihelja Žaja

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The purpose of this paper is to analyze the influence and relative share of underwriting risks in explaining the variation in insurance cycles in subsequent periods. Through the insurance contracts they underwrite, insurance companies assume risks. Underwriting risks include pricing risk, reserve risk, reinsurance risk and occurrence risk. These risks pose major risks for property and liability insurers, and therefore their impact on the insurance cycle is important. The main goal of this paper is to determine the relative proportion of underwriting risks in explaining the variation of insurance cycle. In order to fulfill the main goal of the paper vector autoregressive model, VAR, will be applied.

Keywords: Insurance cycle, insurance risks, combined ratio, Republic of Croatia.

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Authors: Mohd Zuhair, Ram Babu Roy

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This paper presents an overview of the accessibility, design, and functioning of health insurance plans launched by state governments in India. In recent years, the governments of several states in India have come forward to provide health insurance coverage for the low-income group and rural population to reduce the out of pocket expenditure (OPE) on healthcare. Different health insurance schemes have different structures and offerings which differ in the different demographic factors. This study will portray a comparative analysis of the various health insurance schemes by analyzing different offerings and finance generation of the schemes. The comparative analysis will explain the lesson to be learned from these schemes and extend the existing knowledge of the health insurance in India. This would help in recognizing tension between various drivers and identifying issues pertaining to the sustainability of health insurance schemes in India.

Keywords: Health insurance, out of pocket expenditure, universal healthcare, sustainability.

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Authors: Jinming Ma, Tianbing Xia, Janusz R. Getta

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This paper presents the application of fuzzy set theory to implement of mobile advertisement anti-fraud systems. Mobile anti-fraud is a method aiming to identify mobile advertisement fraudsters. One of the main problems of mobile anti-fraud is the lack of evidence to prove a user to be a fraudster. In this paper, we implement an application by using fuzzy set theory to demonstrate how to detect cheaters. The advantage of our method is that the hardship in detecting fraudsters in small data samples has been avoided. We achieved this by giving each user a suspicious degree showing how likely the user is cheating and decide whether a group of users (like all users of a certain APP) together to be fraudsters according to the average suspicious degree. This makes the process more accurate as the data of a single user is too small to be predictable.

Keywords: Mobile internet, advertisement, anti-fraud, fuzzy set theory.

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Authors: Vasudev Das

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The specific problem is that private and public organizational leaders often do not understand the importance of sonic therapeutic intervention in preventing financial fraud. The study aimed to explore sonic therapeutic intervention practitioners' lived experiences regarding the value of sonic therapeutic intervention in preventing financial fraud. The data collection methods were semi-structured interviews of purposeful samples and documentary reviews, which were analyzed thematically. Four themes emerged from the analysis of interview transcription data: Sonic therapeutic intervention enabled self-control, pro-spiritual values, consequentiality mindset, and post-conventional consciousness. The itemized four themes helped non-engagement in financial fraud. Implications for positive social change include enhanced financial fraud management, more significant financial leadership, and result-oriented decision-taking in the financial market. Also, the study results can improve the increased de-escalation of anxiety/stress associated with defrauding.

Keywords: consciousness, consequentiality, rehabilitation, reintegration

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Authors: Yu-Chun Lin

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We identify clawback triggers from firms- proxy statements (Form DEF 14A) and use the likelihood of restatements to proxy for financial reporting quality. Based on a sample of 578 U.S. firms that voluntarily adopt clawback provisions during 2003-2009, when restatement-based triggers could be decomposed into two types: fraud and unintentional error, and we do observe the evidence that using fraud triggers is associated with high financial reporting quality. The findings support that fraud triggers can enhance deterrent effect of clawback provision by establishing a viable disincentive against fraud, misconduct, and otherwise harmful acts. These results are robust to controlling for the compensation components, to different sample specifications and to a number of sensitivity.

Keywords: Accruals quality, Clawback provisions, Compensation, Restatements.

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Authors: Papathanasiou Anastasios, Liontos George, Liagkou Vasiliki, Glavas Euripides

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The purpose of this paper is to describe the growing problem of various cyber fraud schemes that exist on the internet and are currently among the most prevalent. The main focus of this paper is to provide a detailed description of the modus operandi, tools, and techniques utilized in four basic typologies of cyber frauds: Business Email Compromise (BEC) attacks, investment fraud, romance scams, and online sales fraud. The paper aims to shed light on the methods employed by cybercriminals in perpetrating these types of fraud, as well as the strategies they use to deceive and victimize individuals and businesses on the internet. Furthermore, this study outlines defense strategies intended to tackle the issue head-on, with a particular emphasis on the crucial role played by European legislation. European legislation has proactively adapted to the evolving landscape of cyber fraud, striving to enhance cybersecurity awareness, bolster user education, and implement advanced technical controls to mitigate associated risks. The paper evaluates the advantages and innovations brought about by the European legislation while also acknowledging potential flaws that cybercriminals might exploit. As a result, recommendations for refining the legislation are offered in this study in order to better address this pressing issue.

Keywords: Business email compromise, cybercrime, European legislation, investment fraud, Network and Information Security, online sales fraud, romance scams.

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Authors: Guanqun Shi, Xueqing Zhang

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The frequent occurrence of failures in PPP projects which caused great loss has raised attention from the government as well as the concessionaire. PPPs are complex arrangements for its long operation period and multiple players. Many types of risks in PPP projects may cause the project fail. The insurance is an important tool to transfer the risks. Through a comparison and analysis of international government PPP guidelines and contracts as well as the case studies worldwide, we have identified eight main insurance principles, discussed thirteen insurance types in different stages. An overall procedure would be established to improve the practices in PPP projects.

Keywords: Public-private partnerships, insurance, contract, risk.

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Authors: Fatimah Almah Saaid, Darfiana Nur, Robert King

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This paper presents a procedure for estimating VAR using Sequential Discounting VAR (SDVAR) algorithm for online model learning to detect fraudulent acts using the telecommunications call detailed records (CDR). The volatility of the VAR is observed allowing for non-linearity, outliers and change points based on the works of [1]. This paper extends their procedure from univariate to multivariate time series. A simulation and a case study for detecting telecommunications fraud using CDR illustrate the use of the algorithm in the bivariate setting.

Keywords: Telecommunications Fraud, SDVAR Algorithm, Multivariate time series, Vector Autoregressive, Change points.

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Authors: Chimaobi V. Okolo, Afamefuna J. Ani, Ebere U. Okolo

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This paper seeks to assess the implications of insurance to foreign direct investment inflow in Nigeria. Multiple linear regression technique and correlation matrix test were employed to measure the extent to which foreign direct investment was influenced. The result showed that insurance premium (IP), asset size of insurance industry (AS), and total investment of the industry (TI) impacted significantly and positively on foreign direct investment inflow in Nigeria. There should be effective risk transfer mechanism and financial intermediation, which gives the investor confidence in the risk management strength of the host country.

Keywords: Foreign direct investment, insurance.

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Authors: Jennifer Leach, Umashanger Thayasivam

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The use of technology has benefited society in more ways than one ever thought possible. Unfortunately, as society’s knowledge of technology has advanced, so has its knowledge of ways to use technology to manipulate others. This has led to a simultaneous advancement in the world of fraud. Machine learning techniques can offer a possible solution to help decrease these advancements. This research explores how the use of various machine learning techniques can aid in detecting fraudulent activity across two different types of fraudulent datasets, and the accuracy, precision, recall, and F1 were recorded for each method. Each machine learning model was also tested across five different training and testing splits in order to discover which split and technique would lead to the most optimal results.

Keywords: Data science, fraud detection, machine learning, supervised learning.

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Authors: Fury Khristianty Fitriyah

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This study aims to identify the extent of the role of the Satuan Pengawas Intern (Internal Audit Unit) in detecting and preventing fraud in public universities in West Java under the Ministry of Research, Technology and Higher Education. The research method applied was a qualitative case study approach, while the unit of analysis for this study is the Internal Audit Unit at each public university. Results of this study indicate that the Internal Audit Unit is able to detect and prevent fraud within a public university environment by means of red flags to mark accounting anomalies. These stem from inaccurate budget planning that prompts inappropriate use of funds, exacerbated by late disbursements of funds, which potentially lead to fictitious transactions, and discrepancies in recording state-owned assets into a state property management system (SIMAK BMN), which, if not conducted properly, potentially causes loss to the state.

Keywords: Internal Audit Unit, efficiency, fraud, public university.

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Authors: Francesco Venuti, Simona Alfiero

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The aim of this paper is to develop an empirical research on the nature and consequences of corporate governance on Eurozone Insurance Industry risk taking attitude. More particularly, we analyzed the effect of public ownership on risk taking with respect to privately held Insurance Companies. We also analyzed the effects on risk taking attitude of different degrees of ownership concentration, directors compensation, and the dimension/diversity of the Board of Directors. Our results provide quite strong evidence that, coherently with the Agency Theory, publicly traded insurance companies with more concentrated ownership are less risky than the corresponding privately held.

Keywords: Agency theory, corporate governance, insurance companies, risk taking.

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Authors: Ifedapo Francis Awolowo

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The unrelenting series of embarrassing audit failures should stimulate a paradigm shift in accounting. And in this age of information revolution, there is need for a constant improvement on the products or services one offers to the market in order to be relevant. This study explores the perceptions of external auditors, forensic accountants and accounting academics on whether a paradigm shift to forensic accounting can reduce financial statement frauds. Through Neo-empiricism/inductive analytical approach, findings reveal that a paradigm shift to forensic accounting might be the right step in the right direction in order to increase the chances of fraud prevention and detection in the financial statement. This research has implication on accounting education on the need to incorporate forensic accounting into present day accounting curriculum. Accounting professional bodies, accounting standard setters and accounting firms all have roles to play in incorporating forensic accounting education into accounting curriculum. Particularly, there is need to alter the ISA 240 to make the prevention and detection of frauds the responsibilities of bot those charged with the management and governance of companies and statutory auditors.

Keywords: Financial statement fraud, forensic accounting, fraud prevention and detection, auditing, audit expectation gap, corporate governance.

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Authors: Jamel Miri, Bechir Nsiri, Ridha Bouallegue

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Ultra WidBand-IR physical layer technology has seen a great development during the last decade which makes it a promising candidate for short range wireless communications, as they bring considerable benefits in terms of connectivity and mobility. However, like all wireless communication they suffer from vulnerabilities in terms of security because of the open nature of the radio channel. To face these attacks, distance bounding protocols are the most popular counter measures. In this paper, we presented a protocol based on distance bounding to thread the most popular attacks: Distance Fraud, Mafia Fraud and Terrorist fraud. In our work, we study the way to adapt the best secure distance bounding protocols to mapping code of ultra-wideband (TH-UWB) radios. Indeed, to ameliorate the performances of the protocol in terms of security communication in TH-UWB, we combine the modified protocol to ultra-wideband impulse radio technology (IR-UWB). The security and the different merits of the protocols are analyzed.

Keywords: Distance bounding, mapping code ultra-wideband, Terrorist Fraud.

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Authors: Shu-Lin Lin, Ching-Chien Yang

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This study examines the influence of information transparency and corporate governance on purchase directors and officers liability (D&O) insurance decisions. The results show that companies with greater information transparency have significant demand for D&O insurance. Greater transparency in voluntary disclosures is significantly and positively associated with demand for insurance, indicating that increasing the degree of information disclosure reduces information asymmetry for insurers, which stimulates their willingness to provide greater protection. Analysis of insured and uninsured subsamples indicates that uninsured companies have superior corporate governance compared to insured companies. Although insured companies tend to have weaker corporate governance structures, they appoint Big 4 firms or industry experts to compensate for the weakness of their corporate governance. Empirical results indicate that purchasing D&O insurance can strengthen external corporate governance and increase companies’ willingness to voluntarily provide more transparent information.

Keywords: Directors and officers liability (D&O) insurance, information transparency, corporate governance, Big 4.

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Authors: Niloofar Yousefi, Marie Alaghband, Ivan Garibay

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With the increase of credit card usage, the volume of credit card misuse also has significantly increased, which may cause appreciable financial losses for both credit card holders and financial organizations issuing credit cards. As a result, financial organizations are working hard on developing and deploying credit card fraud detection methods, in order to adapt to ever-evolving, increasingly sophisticated defrauding strategies and identifying illicit transactions as quickly as possible to protect themselves and their customers. Compounding on the complex nature of such adverse strategies, credit card fraudulent activities are rare events compared to the number of legitimate transactions. Hence, the challenge to develop fraud detection that are accurate and efficient is substantially intensified and, as a consequence, credit card fraud detection has lately become a very active area of research. In this work, we provide a survey of current techniques most relevant to the problem of credit card fraud detection. We carry out our survey in two main parts. In the first part, we focus on studies utilizing classical machine learning models, which mostly employ traditional transnational features to make fraud predictions. These models typically rely on some static physical characteristics, such as what the user knows (knowledge-based method), or what he/she has access to (object-based method). In the second part of our survey, we review more advanced techniques of user authentication, which use behavioral biometrics to identify an individual based on his/her unique behavior while he/she is interacting with his/her electronic devices. These approaches rely on how people behave (instead of what they do), which cannot be easily forged. By providing an overview of current approaches and the results reported in the literature, this survey aims to drive the future research agenda for the community in order to develop more accurate, reliable and scalable models of credit card fraud detection.

Keywords: credit card fraud detection, user authentication, behavioral biometrics, machine learning, literature survey

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Authors: T. Pavic Kramaric, M. Kitic

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The purpose of this article is to analyze the market structure as well as the degree of concentration in insurance markets in new EU member states. The analysis was conducted using several most commonly used concentration indicators such as concentration ratio, Herfindahl-Hirschman index and entropy index. These indicators were calculated for the 2000-2010 period on the basis of total gross written premium as the most relevant indicator of market power in insurance markets. The results of the analysis showed that in all observed countries the level of concentration decreased, though with significantly different intensity. Yet, in some countries, the level of concentration remains very high.

Keywords: insurance market, concentration, new EU member states

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Authors: Rasheed Gbenga Jimoh, Akinbowale Nathaniel Babatunde

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The use of Automated Teller Machine (ATM) has become an important tool among commercial banks, customers of banks have come to depend on and trust the ATM conveniently meet their banking needs. Although the overwhelming advantages of ATM cannot be over-emphasized, its alarming fraud rate has become a bottleneck in it’s full adoption in Nigeria. This study examined the menace of ATM in the society another cost of running ATM services by banks in the country. The researcher developed a prototype of an enhanced Automated Teller Machine Authentication using Short Message Service (SMS) Verification. The developed prototype was tested by Ten (10) respondents who are users of ATM cards in the country and the data collected was analyzed using Statistical Package for Social Science (SPSS). Based on the results of the analysis, it is being envisaged that the developed prototype will go a long way in reducing the alarming rate of ATM fraud in Nigeria.

Keywords: ATM, ATM Fraud, E-banking, Prototyping.

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Authors: Vesna Bosilj Vukšić, Darija Ivandić Vidović, Ljubica Milanović Glavan

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Information technology plays an irreplaceable role in introducing and improving business process orientation in a company. It enables implementation of the theoretical concept, measurement of results achieved and undertaking corrective measures aimed at improvements. Information technology is a key concept in the development and implementation of the business process management systems as it establishes a connection to business operations. Both in the literature and practice, insurance companies are often seen as highly process oriented due to the nature of their business and focus on customers. They are also considered leaders in using information technology for business process management. The research conducted aimed to investigate whether the perceived leadership status of insurance companies is well deserved, i.e. to establish the level of process orientation and explore the practice of information technology use in insurance companies in the region. The main instrument for primary data collection within this research was an electronic survey questionnaire sent to the management of insurance companies in the Republic of Croatia, Bosnia and Herzegovina, Slovenia, Serbia and Macedonia. The conducted research has shown that insurance companies have a satisfactory level of process orientation, but that there is also a huge potential for improvement, especially in the segment of information technology and its connection to business processes.

Keywords: Business processes management, process orientation, information technology, insurance companies.

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Authors: Narendra M. Shekokar, Satish R. Devane

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In a recent year usage of VoIP subscription has increased tremendously as compare to Public Switching Telephone System(PSTN). A VoIP subscriber would like to know the exact tariffs of the calls made using VoIP. As the usage increases, the rate of fraud is also increases, causing users complain about excess billing. This in turn hampers the growth of VoIP .This paper describe the common frauds and attack on VoIP based system and make an attempt to solve the billing attack by creating secured channel between caller and callee.

Keywords: VoIP, Billing-fraud, SSL/TLS, MITM, Replay-attack.

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Authors: Yuthapoom Thanakijborisut

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This paper studies consumption insurance against the chronic illness in Thailand. The study estimates the impact of household consumption in the chronic illness on consumption growth. Chronic illness is the health care costs of a person or a household’s decision in treatment for the long term; the causes and effects of the household’s ability for smooth consumption. The chronic illnesses are measured in health status when at least one member within the household faces the chronic illness. The data used is from the Household Social Economic Panel Survey conducted during 2007 and 2012. The survey collected data from approximately 6,000 households from every province, both inside and outside municipal areas in Thailand. The study estimates the change in household consumption by using an ordinary least squares (OLS) regression model. The result shows that the members within the household facing the chronic illness would reduce the consumption by around 4%. This case indicates that consumption insurance in Thailand is quite sufficient against chronic illness.

Keywords: Consumption insurance, chronic illness, health care, Thailand.

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Authors: W. T. Hsu, H. L. Tsai

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The rapid aging of the population is a common trend in the world. However, the progress of modern medical technology has increased the average life expectancy. The global population structure has changed dramatically, and the elderly population has risen rapidly. In the face of rapid population growth, it must be noted issues of the aging population must face up to, which are the physiological, psychological, and social problems associated with aging. This study aims to investigate how insurance agents are actively dealing with an aging society, their own aging anxiety, and their exercise habits. Purposive sampling was the sampling method of this study, a total of 204 respondents were surveyed and 204 valid surveys were returned. The returned valid ratio was 100%. Statistical method included descriptive statistics, t-test, and one-way ANOVA. The results of the study found that the insurance agent’s age, seniority, exercise habits to aging anxiety are significantly different.

Keywords: Insurance agent, aging anxiety, exercise habits, elderly.

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Authors: Tahseen A. Jilani, S. M. Aqil Burney, C. Ardil

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In this paper, we have presented a new multivariate fuzzy time series forecasting method. This method assumes mfactors with one main factor of interest. History of past three years is used for making new forecasts. This new method is applied in forecasting total number of car accidents in Belgium using four secondary factors. We also make comparison of our proposed method with existing methods of fuzzy time series forecasting. Experimentally, it is shown that our proposed method perform better than existing fuzzy time series forecasting methods. Practically, actuaries are interested in analysis of the patterns of causalities in road accidents. Thus using fuzzy time series, actuaries can define fuzzy premium and fuzzy underwriting of car insurance and life insurance for car insurance. National Institute of Statistics, Belgium provides region of risk classification for each road. Thus using this risk classification, we can predict premium rate and underwriting of insurance policy holders.

Keywords: Average forecasting error rate (AFER), Fuzziness offuzzy sets Fuzzy, If-Then rules, Multivariate fuzzy time series.

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Authors: Zina Benouaret, Djamil Aissani

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In this work, we introduce the qualitative and quantitative concept of the strong stability method in the risk process modeling two lines of business of the same insurance company or an insurance and re-insurance companies that divide between them both claims and premiums with a certain proportion. The approach proposed is based on the identification of the ruin probability associate to the model considered, with a stationary distribution of a Markov random process called a reversed process. Our objective, after clarifying the condition and the perturbation domain of parameters, is to obtain the stability inequality of the ruin probability which is applied to estimate the approximation error of a model with disturbance parameters by the considered model. In the stability bound obtained, all constants are explicitly written.

Keywords: Markov chain, risk models, ruin probabilities, strong stability analysis.

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Authors: F. Havas Beigi, E. Mohammadi, M.Vafaee Yeganeh

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Curriculum is one of the most important inputs in higher education system and for knowing the strong and weak spots of it we need evaluation. The main purpose of this study was to survey of the curriculum quality of Insurance Management field. Case: University of Allameh Taba Tabaee(according to view point of students,alumni,employer and faculty members).Descriptive statistics (mean, tables, percentages, frequency distribution) and inferential statistics (CHI SQUARE) were used to analyze the data. Six criterions considered for the Quality of curriculum: objectives, content, teaching and learning methods, space and facilities, Time, assessment of learning. objectives, teaching and learning methods criterions was desirable level, content criteria was undesirable level, space and facilities, time and assessment of learning were rather desirable level. The quality of curriculum of insurance management field was relatively desirable level.

Keywords: Quality, curriculum, insurance management, higher education.

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Authors: S. Kotsiantis, E. Koumanakos, D. Tzelepis, V. Tampakas

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This paper explores the effectiveness of machine learning techniques in detecting firms that issue fraudulent financial statements (FFS) and deals with the identification of factors associated to FFS. To this end, a number of experiments have been conducted using representative learning algorithms, which were trained using a data set of 164 fraud and non-fraud Greek firms in the recent period 2001-2002. The decision of which particular method to choose is a complicated problem. A good alternative to choosing only one method is to create a hybrid forecasting system incorporating a number of possible solution methods as components (an ensemble of classifiers). For this purpose, we have implemented a hybrid decision support system that combines the representative algorithms using a stacking variant methodology and achieves better performance than any examined simple and ensemble method. To sum up, this study indicates that the investigation of financial information can be used in the identification of FFS and underline the importance of financial ratios.

Keywords: Machine learning, stacking, classifier.

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