Fraud, waste, and abuse in the U.S. healthcare system are estimated at $700 billion annually. Predictive analytics offers government and private payers the opportunity to identify and prevent or recover such billings. This paper proposes a data-driven method for fraud detection based on comparative research, fraud cases, and literature review. Unsupervised data mining techniques such as outlier...

Why are auditors unable to detect fraudulent financial reporting in some audits? Should auditors be able to anticipate when fraud is likely to occur? Various studies have discussed not only the need for experience and supervision of auditors, but also the effect of decision models, and even expert systems, on fraud detection and the study of internal controls. This paper presents a discussion o...

GSM (Global Services of Mobile Communications) 1800 licenses were granted in the beginning of the 2000’s in Turkey. Especially in the installation phase of the wireless telecom services, fraud usage can be an important source of revenue loss. Fraud can be defined as a dishonest or illegal use of services, with the intention to avoid service charges. Fraud detection is the name of the activities...

All over the world we have been assisting to a significant increase of the telecommunication systems usage. People are faced day after day with strong marketing campaigns seeking their attention to new telecommunication products and services. Telecommunication companies struggle in a high competitive business arena. It seems that their efforts were well done, because customers are strongly adop...

Adam Graycar Director The plastic card industry is being targeted by organised criminal enterprise from around the world. In the past, Australia’s physical isolation from the rest of the world protected us, to some extent, from fraud trends which were taking place elsewhere. Computers, telecommunications systems, and international travel, now allow Australia to experience the same kinds of frau...

The vast growth of the payment card industry (PCI) in the last 50 years has placed the industry in the centre of attention, not only because of this growth, but also because of the increase of fraudulent transactions. The conducted research in this domain has JIBC December 2009, Vol. 14, No. 3 produced statistical reports on detection of fraud, and ways of protection. On the other hand, the rel...

Due to the rise of technology, the possibility of fraud in different areas such as banking has been increased. Credit card fraud is a crucial problem in banking and its danger is over increasing. This paper proposes an advanced data mining method, considering both feature selection and decision cost for accuracy enhancement of credit card fraud detection. After selecting the best and most effec...

The Federal Reserve Banks of Boston and Atlanta convened a meeting of the Mobile Payments Industry Workgroup (MPIW) in November 2015 to discuss payments in the card-not-present (CNP) environment. Not only are consumers increasingly using mobile devices to initiate CNP payments; but the e-commerce fraud rate in the U.S. is expected to increase significantly as EMV2 chip card migration progresses...

Fraud and abuse have led to significant additional expense in the health care system of the United States. This paper aims to provide a comprehensive survey of the statistical methods applied to health care fraud detection, with focuses on classifying fraudulent behaviors, identifying the major sources and characteristics of the data based on which fraud detection has been conducted, discussing...