• Journal of the Korea Society of Computer and Information
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• v.25 no.3
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• pp.117-127
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• 2020

Recently, proving insurance fraud has become increasingly difficult because it occurs intentionally and secretly via organized and intelligent conspiracy by specialists such as medical personnel, maintenance companies, insurance planners, and insurance subscribers. In the case of car accidents, it is difficult to prove intentions; in particular, an insurance company with no investigation rights has practical limitations in proving the suspicions. This paper aims reveal that the detection of organized and conspired insurance fraud, which had previously been difficult, could be dramatically improved through conspiring insurance fraud detection modeling using social network analysis and visualization of the relation between suspected group entities and by seeking developmental research possibilities of data analysis techniques.

• Information Systems Review
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• v.5 no.1
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• pp.49-60
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• 2003

The purpose of this study is to empirically and practically verify the applicability of visualization data mining tool in detecting real-word insurance frauds that are now emerged as one of the most serious problems socially and economically. For the verification, Analyst's Notebook by i2, which has been known as the most effective visualization data mining tool, was adopted. With Analyst's Notebook, fraud-probable insurance transactions from a very large insurance claims are selected and then substantiation for insurance frauds are attempted. The results show that Analyst's Notebook not only detects insurance fraud transactions from a vast number of insurance claims, but is also able to pinpoint organized crime group by associating one fraud transaction to another fraud transaction. Therefore, it is safe to conclude that visualization data mining is very effective in detecting false transactions and crime behaviors including insurance fraud.

• Journal of Digital Convergence
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• v.20 no.2
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• pp.241-250
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• 2022

Due to the COVID-19 pandemic, with increased 'untact' services and with unstable household economy, the bike insurance fraud is expected to surge. Moreover, the fraud methodology gets complicated. However, the fraud detection model for bike insurance is absent. we deal with the issue of skewed class distribution and reflect the criterion of fraud detection expert. We utilize a balanced random-forest algorithm to develop an efficient bike insurance fraud detection model. As a result, while the predictive performance of balanced random-forest model is superior than it of non-balanced model. There is no significant difference between the variables used by the experts and the confirmatory models. The important variables to detect frauds are turned out to be age and gender of driver, correspondence between insured and driver, the amount of self-repairing claim, and the amount of bodily injury liability.

• The Korean Journal of Financial Management
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• v.23 no.1
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• pp.227-242
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• 2006

This paper analyzes insurance crimes using a game theoretic model. In blackmailing cases involving automobile accidents, insurance criminals deliberately induce innocent drivers(victims) to commit a moving violation such as crossing over the center dividing yellow line, and collide with the victims. After the collision, the criminals and the victims effectively engage in a bargaining game over the amount of the settlement for the damage. Because the penalty for that kind of moving violation is very severe (even criminally prosecuted), the victims do not have much bargaining power. Exploiting the weak bargaining power of the victims, the criminals demand and receive huge compensation (including settlement) from the victims. In the model, it is shown that under the current law agents have perverse incentives leading to insurance crimes. The criminals have incentive to induce car collisions and extract huge settlement from the victims. Based on the analysis, it is suggested that lowering the severity of penalty for certain kind of violation may be needed to prevent insurance crimes, in addition to increasing the crime investigation activities and strengthening punishment for insurance criminals.

• Proceedings of the Korean Operations and Management Science Society Conference
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• 1995.09a
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• pp.344-344
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• 1995

• Convergence Security Journal
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• v.15 no.6_2
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• pp.79-87
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• 2015

In order to clearly recognize illegality of insurance crime, declaring the provisions on insurance crime is preferable. An insurance fraud differentiated from Configuration Requirements of general fraud should be established And differentiation in accordance with the act type of insurance crime the degree of organizational involvement is required. Also the introduction of civil sanctions and creation of additional punishment provision about Organized insurance fraud are required. To notice duplicate insurance when sign up life insurance, the revision of the provisions is required. To limit unnecessary long-term hospitalization, hospitalization standard is required. Introduction of private investigator is required as a method for endowing with investigation to the staff of insurance companies. By providing information sharing laws between relevant agencies including insurance companies and law enforcement agencies, the foundation of information database, and the introduction of SNA Techniques in the IFAS,, you can detect Organized collusion crime.

• Vending industry
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• v.3 no.1 s.9
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• pp.64-69
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• 2004

고수익을 미끼로 한 자판기 분양사기가 최근 급증하고 있어 큰 문제가 되고 있다. 무조건 자판기 수익성만을 과대포장하여 투자자들의 `묻지마` 투자를 유도한 후 돈만 챙기고 사업에서 손을 떼어버리는 사기행각은 그 피해대상이 대부분 서민이라는 점에서 문제의 심각성을 더한다. 자판기가 불법 자금 모집을 통해 사기의 대상으로 외부 인식이 악화되어 버린다면 자판기 산업의 입지 역시 크게 좁혀 질 수 밖에 없다. 자판기 품목에 있어서는 불법자금모집의 대표적인 사례가 되는 경우는 확정수익을 보장한다며 투자자를 모집하는 경우이다. 그 후 일정기간동안 수익을 보장하며 투자자를 안심시킨 다음 일순간 돌변하여 자금을 챙겨 잠적을 하는 수순을 밝는다. 선의의 투자자들은 이럴 경우 엄청난 피해를 입게 되는 게 보통이다. 대개의 경우 기계 1~2대의 소량물량이 아닌 5대~l0대 단위의 투자를 유도하기 때문이다. 이제는 자판기 산업에 있어 이러한 악성 불법자금 모집업체들이 근절되어야 한다. 이 불법 사기행각의 대상이 더 이상 자판기 분야에 발을 붙이지 못하도록 하는 제도적 비책이 시급히 강구 되어야 한다. 이러한 가운데 금융감독원 비은행감독국 비제도금융조사팀에서는 올들어 지난 9월말까지 고수익을 미끼로 투자자금을 모집하다가 금감원에 적발된 유사 금융업체 85개사 명단을 사법당국에 통보했다. 불법자금모집 업체들이 투자자들을 유혹하기위해 미끼로 내세운 사업을 종류별로 보면 자판기, 게임기, 컴퓨터단말기 등 특정상품 운영권 제공이 29개사로 가장 많고, 사이버 쇼핑몰 및 인터넷사업(18개사), 납골당 등 부동산 투자(12개사), 영화등 문화 및 레저사업(10개사), 영화문화 및 레저산업(10개사), 벤처투자사(9개사) 등이었다. 자판기 분야에 있어서는 주로 성인용품자판기, 복권자판기 등의 품목이 불법자금 모집의 집중 타킷이 되었다. 금감원은 최근들어 유사 금융업체의 자금모집이 전문가도 속을 정도로 지능화하고 있다며 개인투자자들이 피해를 예방할 수 있는 불법업체 식별법을 금감원 인터넷 사이트(www.fss.or.kr)에 게시했다. 금감원은 특히 사업현황에 대해 지나치게 보안을 유지하는 업체, 1백$\%$이상의 터무니없는 고수익을 보장한다고 광고하는 업체, 제도권 금융회사의 지급보증을 강조하는 업체에 대해서는 투자에 앞서 금감원이나 업종 관련 정부당국에 사실여부를 확인해 보고 투자여부를 결정하라고 통보했다. 아울러 금감원은 금융소비자들이나 자판기 업계에서 불법자금 모집업체를 발견하여 전화(02-3786-8155~9)나 인터넷소비자 보호센터와 경찰에 신고해줄 것을 요청했다. 이제는 산업계도 더 이상 자판기 분야의 불법자금업체를 방치하지 말고 적극적인 금감원 신고를 통해 시장을 정화할 수 있게 해야 한다. 미꾸라지 한두마리가 온 개천 물 다 흐려놓는 이치처럼 자판기불법자금업체들로 인해 전체 산업에 미치는 영향이 실로 심각함을 인식해야 할 때이다. 금호 산업정보에서는 산업계에서 불법자금업체 근절에 많은 관심을 가질 수 있게 하기 위해 금융감독원 비은행감독국 비제도금융조사팀에서 배포한 $\ulcorner$불법자금 모집업체 고수익 보장 유혹에 주의$\lrcorner$ 에 대한 보도자료의 세부내용을 게재한다.

• Korean Security Journal
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• no.32
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• pp.151-176
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• 2012

Government organizations (including police, prosecutor, and Financial Supervisory Service) and programs to uncover or prevent from insurance crime are not well developed. However, insurance crime are increasing among not only private insurances such as life insurance, indemnity insurance, and auto insurance but also public insurances including national health insurance and industrial accident compensation insurance. The damages of crimes are serious in both economical and ethical perspectives. Insurance crime deteriorates a current account of insurance companies and the leakages due to insurance fraud worsen loss ratio. Consequently, insurance crime increases customers' costs of insurance. For this reason, insurance companies stated to establish Special Investigation Unit(SIU) to detect insurance crime and fraud by themselves. However, organizational and operational efficiencies are limited. The purpose of this study is to examine the relationship between work environment factors, perception of insurance crime and job satisfaction among Special Investigation Units. Therefore, this study investigated the perception of work environments of Special Investigation Units. In addition, this study examined how their work environments and general perception of insurance crime influence their job satisfaction. In order test the purpose of this study, reliability test, exploratory factor analysis(EFA), multiple regression were employed. The results of this study suggested that clarity of insurance company, distress/difficulty of resolve, compensation, perception of work pressure are statistically significant on jab satisfaction among Special Investigation Unit in South Korea. This exploratory study expected to contribute to understanding of Special Investigation Unit, and their insurance crime prevention system. The results from this analysis will be examined in light of previous findings and policy implications discussed.

• Convergence Security Journal
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• v.16 no.6_2
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• pp.53-60
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• 2016

Security measures for the current insurance crime has focused on the capture oriented and reactive response in the screening stage of insurance payments. However, since leaving the damages that can not be healed by post-punishment, it is necessary to take measures to prevent the insurance crimes in advance. In this paper, I would like to try to identify problems through analyzing the characteristics and cases of the insurance crimes, and to present alternatives to it. The problems with the current insurance system that causes the insurance crimes are, First, When signing the insurance contract, it is too inattentive to confirm about the credit status of the policyholder, duplicate join or not, whether voluntarily sign up etc. Second, a thorough investigation or criminal charges in case of insurance accident is not being done properly. Third, information exchange and management to malicious policyholders is not being done properly. Therefore, in order to guard people from insurance crimes, First, it should strengthen the audit of such credit conditions, accident experiences in the insurance contract at the policyholders. Second, we need to block insurance crimes in advance through the continuous upgrades of insurance fraud analysis systems and social network. Third, it is necessary to strengthen the surveillance systems for the insurance crimes by the information sharing.

• Journal of the Korea Institute of Information Security & Cryptology
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• v.22 no.4
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• pp.851-868
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• 2012

After the financial crisis in 2008, the financial market still seems to be unstable with expanding the insolvency of the financial companies' real estate project financing loan in the aftermath of the lasted real estate recession. Especially after the illegal actions of people's financial institutions disclosed, while increased the anxiety of economic subjects about financial markets and weighted in the confusion of financial markets, the potential risk for the overall national economy is increasing. Thus as economic recession prolongs, the people's financial institutions having a weak profit structure and financing ability commit illegal acts in a variety of ways in order to conceal insolvent assets. Especially it is hard to find the loans of shareholder and the same borrower sharing credit risk in advance because most of them usually use a third-party's name bank account. Therefore, in order to effectively detect the fraud under other's name, it is necessary to analyze by clustering the borrowers high-related to a particular borrower through an analysis of association between the whole borrowers. In this paper, we introduce Analysis Techniques for detecting financial loan frauds in advance through an analysis of association between the whole borrowers by extending SNA(social network analysis) which is being studied by focused on sociology recently to the forensic accounting field of the financial frauds. Also this technique introduced in this pager will be very useful to regulatory authorities or law enforcement agencies at the field inspection or investigation.