Insurance Fraud: Issues and Challenges

This article is devoted to the phenomenon of insurance fraud. We start by surveying the various forms of insurance fraud as well as its extent and cost. We proceed to analyse the problem as the product of motivation and opportunity, and address the complexities of fraud control. Finally, we provide a high-level overview of current anti-fraud activity.

[1]  Guido Dedene,et al.  A case study of applying boosting naive Bayes to claim fraud diagnosis , 2004, IEEE Transactions on Knowledge and Data Engineering.

[2]  John A. Major,et al.  EFD: A Hybrid Knowledge/Statistical-Based System for the Detection of Fraud , 2002 .

[3]  R. Derrig,et al.  Prosecuting Insurance Fraud—A Case Study of the Massachusetts Experience in the 1990s , 2002 .

[4]  Sharon Tennyson,et al.  Claims Auditing in Automobile Insurance: Fraud Detection and Deterrence Objectives , 2002 .

[5]  Mercedes Ayuso,et al.  Detection of Automobile Insurance Fraud with Discrete Choice Models and Misclassified Claims , 2002 .

[6]  Patrick L. Brockett,et al.  Fraud Classification Using Principal Component Analysis of Ridits , 2002 .

[7]  Jack L. VanDerhei.  The Role of Company Stock in 401(K) Plans , 2002 .

[8]  R. Derrig.  Insurance Fraud , 1996 .

[9]  D. Bolduc,et al.  Workers' Compensation, Moral Hazard, and the Composition of Workplace Injuries , 2002 .

[10]  Guido Dedene,et al.  A Comparison of State-of-The-Art Classification Techniques for Expert Automobile Insurance Claim Fraud Detection , 2002 .

[11]  Peter Grabosky,et al.  The Psychology of Fraud , 2001 .

[12]  G. Dionne.  The Empirical Measure of Information Problems with Emphasis on Insurance Fraud and Dynamic Data , 2012 .

[13]  El-Bachir Belhadji,et al.  A Model for the Detection of Insurance Fraud , 2000 .

[14]  L. Weiss.  License to Steal: How Fraud Bleeds America's Health Care System , 2001 .

[15]  P. Chiappori.  Econometric Models of Insurance under Asymmetric Information , 2000 .

[16]  P. Keen,et al.  Electronic Commerce Relationships: Trust by Design , 1999 .

[17]  Mercedes Ayuso,et al.  Modelling different types of automobile insurance fraud behaviour in the Spanish market , 1999 .

[18]  Jeremy Travis.  Fraud Control in the Health Care Industry : Assessing the State of the Art , 1999 .

[19]  G. Dionne,et al.  Insurance fraud estimation: more evidence from the Quebec automobile insurance industry , 1999 .

[20]  Sharon Tennyson,et al.  Costly State Falsification or Verification? Theory and Evidence from Bodily Injury Liability Claims , 1999 .

[21]  Peter J. Lenk,et al.  A Hierarchical Bayesian Model for Predicting the Rate of Nonacceptable In-Patient Hospital Utilization , 1999 .

[22]  Sandra T. Welch,et al.  Insurer vs. Insurance Fraud: Characteristics and Detection , 1999 .

[23]  P. Brockett,et al.  Using Kohonen's Self-Organizing Feature Map to Uncover Automobile Bodily Injury Claims Fraud , 1998 .

[24]  Herbert I. Weisberg,et al.  QUANTITATIVE METHODS FOR DETECTING FRAUDULENT AUTOMOBILE BODILY INJURY CLAIMS , 1998 .

[25]  M. Felson,et al.  Opportunity Makes the Thief Practical theory for crime prevention , 1998 .

[26]  Eric W. Bond,et al.  Hardball and the Soft Touch: The Economics of Optimal Insurance Contracts with Costly State Verification and Endogenous Monitoring Costs , 1997 .

[27]  P. Picard,et al.  Auditing claims in the insurance market with fraud: The credibility issue , 1996 .

[28]  Richard J. Butler,et al.  Increasing claims for soft tissue injuries in workers' compensation: Cost shifting and moral hazard , 1996 .

[29]  David Card,et al.  Is Workers' Compensation Covering Uninsured Medical Costs? Evidence from the “Monday Effect” , 1996 .

[30]  Ken Dornstein.  Accidentally, On Purpose: The Making of a Personal Injury Underworld in America , 1996 .

[31]  Jacques Lawarree,et al.  A prisoner's dilemma model of collusion deterrence , 1996 .

[32]  Krzysztof Ostaszewski,et al.  Fuzzy Techniques of Pattern Recognition in Risk and Claim Classification , 1995 .

[33]  Louis Kaplow.  Optimal Insurance Contracts When Establishing the Amount of Losses Is Costly , 1993 .

[34]  John A. Major,et al.  EFD: A hybrid knowledge/statistical‐based system for the detection of fraud , 1992, Int. J. Intell. Syst..

[35]  Jean Tirole,et al.  Collusion and the Theory of Organizations , 1991 .

[36]  Michael Clarke.  THE CONTROL OF INSURANCE FRAUDA Comparative View , 1990 .

[37]  Susan Guarino Ghezzi,et al.  A PRIVATE NETWORK OF SOCIAL CONTROL: INSURANCE INVESTIGATION UNITS* , 1983 .

[38]  The Effects of Insurance on the Possibilities of Fraud , 1984 .

[39]  R. Townsend.  Optimal contracts and competitive markets with costly state verification , 1979 .

[40]  Lawrence E. Cohen,et al.  Social Change and Crime Rate Trends: A Routine Activity Approach , 1979 .

[41]  R. Gagné,et al.  The Empirical Measure of Information Problems with Emphasis on Insurance Fraud , 2022 .