Fraud detection and prevention systems are based on various technological paradigms but the two prevailing approaches are rule-based reasoning and data mining. In this paper we claim that ontologies, an increasingly popular and widely accepted knowledge representation paradigm, can help both of these approaches be more efficient as far as fraud detection is concerned and we introduce a methodol...

Insurers’ Use of Vehicle Telematics Data Offers Lessons to Other Industries Vehicle telematics technology involves the collection, transmission and analysis of data collected from a device installed in a motor vehicle. Such usage-based driving information is a powerful decision-making tool for auto insurance companies. Decades of auto insurance practices are changing as insurers start to price ...

● Most insurers, public and private, have failed to measure systematically the fraud problem they face. Oblivious to the slightly more technical presentation of some of the material in this Research in Brief is found in the article “Health Care Fraud Control: Understanding the Challenge,” published in the Journal of Insurance Medicine, 28 (November 1996):2, 86–96. We are grateful to the publica...

In this study, I investigate the economic determinants of firms’ propensity to commit securities fraud and the determinants of fraud detection. The analysis is based on a new handcompiled fraud sample of private securities class action litigation suits filed between 1996 and 2003 involving allegations of accounting irregularities. I use econometric methods to account for the unobservability of ...

Medicare and Medicaid fraud costs billions of dollars each year in the US. Investigators have shown that fraud is found in all segments of the health care system. Even though the Canadian system has stricter regulations and tighter controls, can regulators here afford to be complacent about believing that such abuse would not happen here? One province has established an antifraud unit to monito...

In the last eight years, registries for e-business, such as ebXML or UDDI, enabling enterprise of any size and in any geographical location to conduct their businesses on the World Wide Web, were developed. Applications in domains such as insurance (for example, insurance rating), financial services (loans, claims routing and management, fraud detection), government (tax calculations), telecom ...

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), enacted on August 21, 1996 (Public Law 104-19), provides for improved access and renewability with respect to employment-related group health plans, to health insurance coverage sold in connection with group plans, and to the individual market (by amending the Public Health Service Act). The Act's provisions include improv...

— With the developments in the Information Technology and improvements in the communication channels, fraud is spreading all over the world, resulting in huge financial losses. Though fraud prevention mechanisms such as CHIP&PIN are developed, these mechanisms do not prevent the most common fraud types such as fraudulent credit card usages over virtual POS terminals or mail orders. As a result,...

In many real-life decision making situations the default assumption of equal (mis-)classification costs underlying pattern recognition techniques is most likely violated. Consider the case of insurance claim fraud detection for which an early claim screening facility is to be built to decide upon the nature of an incoming claim as either suspicious or not. This decision typically forms the basi...

both academic and auditing firms have been searching for ways to detect corporate fraud. The main objective of this study was to present a model to detect financial reporting fraud by companies listed on Tehran Stock Exchange (TSE) using genetic algorithm. For this purpose, consistent with theoretical foundations, 21 variables were selected to predict fraud in financial reporting that finally, ...