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Optimal Auditing for Insurance Fraud [PDF]
SSRN Electronic Journal, 2003 This article aims at making a bridge between the theory of optimal auditing and current procedures applied to audit files in different markets where scoring is the instrument used to implement an audit strategy. The literature has not yet developed an optimal audit policy for the scoring methodology.
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European Journal on Criminal Policy and Research, 1995
There is no doubt that the cost of fraud against insurers is growing, recent estimates by the Association of British Insurers suggest that as much as £2m is lost every day to fraudsters. Fraud occurs in many different forms against insurers and the varying scams are as legion as any other form of financial crime.
openaire +2 more sources
There is no doubt that the cost of fraud against insurers is growing, recent estimates by the Association of British Insurers suggest that as much as £2m is lost every day to fraudsters. Fraud occurs in many different forms against insurers and the varying scams are as legion as any other form of financial crime.
openaire +2 more sources
2023 4th International Conference on Communication, Computing and Industry 6.0 (C216), 2023
The emergence of hybrid AI/ML fashions has allowed for advanced fraud detection within the insurance enterprise. Combining a couple of AI/ML methods including supervised and unsupervised studying, deep studying, and herbal language processing, can offer ...
Venkata Ramana Saddi +4 more
semanticscholar +1 more source
The emergence of hybrid AI/ML fashions has allowed for advanced fraud detection within the insurance enterprise. Combining a couple of AI/ML methods including supervised and unsupervised studying, deep studying, and herbal language processing, can offer ...
Venkata Ramana Saddi +4 more
semanticscholar +1 more source
A Machine and Deep Learning Framework for Robust Health Insurance Fraud Detection and Prevention
International Journal of Advanced Research in Science, Communication and Technology, 2023Healthcare fraud is the deliberate submission of false information or the fabrication of facts in order to get entitlement payments. As a result, it wastes healthcare funds and raises healthcare expenses.
Suhag Pandya
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Journal of Risk and Insurance, 2002
AbstractInsurance fraud is a major problem in the United States at the beginning of the 21st century. It has no doubt existed wherever insurance policies are written, taking different forms to suit the economic time and coverage available. From the advent of “railway spine” in the 19th century to “trip and falls” and “whiplash” in the 20th century ...
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AbstractInsurance fraud is a major problem in the United States at the beginning of the 21st century. It has no doubt existed wherever insurance policies are written, taking different forms to suit the economic time and coverage available. From the advent of “railway spine” in the 19th century to “trip and falls” and “whiplash” in the 20th century ...
openaire +2 more sources
Centralizing Insurance Fraud Investigation* [PDF]
The Geneva Papers on Risk and Insurance Theory, 2000 The study of insurance fraud and its remedy is a hot topic of research, mainly because the problem of insurance fraud is so widespread. In the United States many state governments have setup agencies to combat fraud. These Insurance Fraud Bureaus (IFB) are typically established to gather information about potential fraudulent claims, and to advise ...
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The Role of Natural Language Processing in Detecting Insurance Fraud
2023 4th International Conference on Communication, Computing and Industry 6.0 (C216), 2023Coverage fraud is an illegal hobby that costs the coverage enterprise billions of bucks yearly and can be difficult to detect without the proper equipment. One technology that could assist in detecting fraud is natural language processing (NLP). NLP is a
Venkata Ramana Saddi +4 more
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Cost-Sensitive Learning for Medical Insurance Fraud Detection With Temporal Information
IEEE Transactions on Knowledge and Data Engineering, 2023Fraudulent activities within the U.S. healthcare system cost billions of dollars each year and harm the wellbeing of many qualifying beneficiaries. The implementation of an effective fraud detection method has become imperative to secure the welfare of ...
Haolun Shi +3 more
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IEEE Transactions on Computational Social Systems
With the continuous development of the health insurance system, the problem of health insurance fraud is becoming more and more prominent. Health insurance fraud not only harms health insurance organizations financially but also causes serious ...
Binsheng Hong +4 more
semanticscholar +1 more source
With the continuous development of the health insurance system, the problem of health insurance fraud is becoming more and more prominent. Health insurance fraud not only harms health insurance organizations financially but also causes serious ...
Binsheng Hong +4 more
semanticscholar +1 more source
IEEE Access
Data imbalance is one of the major challenges in health insurance fraud detection where the distribution of classes within the dataset is significantly skewed, leading statistical models to be biased toward the dominant class.
Supriya Seshagiri +1 more
semanticscholar +1 more source
Data imbalance is one of the major challenges in health insurance fraud detection where the distribution of classes within the dataset is significantly skewed, leading statistical models to be biased toward the dominant class.
Supriya Seshagiri +1 more
semanticscholar +1 more source