• Journal of Information Technology Services
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• v.6 no.2
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• pp.1-18
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• 2007

Many researches have been done in insurance fraud as the amount and frequency of insurance fraud have been increasing continuously. In particular, the development of insurance fraud detection system using large database management techniques including data mining or link analysis based on visual method have been the main research topic in insurance fraud. However, this kinds of detection system were very ineffective to find unintentional insurance fraud happened by accident even though it was so good to find intentional and organized crime insurance fraud. Therefore, this research suggests insurance fraud as an ethical decision making and applies TPB(Theory of Planned Behavior) for the finding of reasons and prevention strategies of unintentional insurance fraud happened by accident. The results of research show that TPB is very appropriate model to explain the behavior of insurance fraud and that insurance agents force to do insurance fraud as affecting perceived behavior control. Therefore, education and pubic relations for insurance fraud are very effective for preventing insurance fraud and developing insurance service industry.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.41-69
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• 2012

First introduced in 1977, Korean health care system reached to national coverage in short period of time never seen before in any other countries, and rated as successful system protecting the health of the public at relatively low price. However, despite those positive evaluations, some of fraudulent medical organizations or pharmacies are hindering the sound development of the national health care system with meticulous false billing exaggerating the number of patients or the days of their treatment. To prevent aforementioned nursing home fraud and false billing, the misconduct should be punished as subject to the criminal law and severally punished for fines and payments which far exceed the expected amount of illicit gains as it is basically violation of criminal fraud, other than the forced return of illicit gains based on civil laws. Furthermore, the Health Insurance Review and Assessment Service should strengthen and complement the fraud investigators, the review process, and the professional training to raise the detection rates. It might also want to review ways to implement whistleblower rewarding system and rewards for evidences of healthcare fraud to overcome the limits of external review.

• 한국IT서비스학회:학술대회논문집
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• 2009.05a
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• pp.357-360
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• 2009

본 연구는 데이터마이닝 기법을 이용하여 건강보험청구료에 있어서 이상정도가 심한 요양기관을 탐지하고, 실제 의료영역에 적용하기 위한 시스템 개발을 목적으로 한다. 현재 건강보험 심사평가원의 이상탐지시스템은 평가대상이 되는 항목을 개별적으로 평가하고, 탐지된 기관의 선정 이유에 대한 근거제시가 부족한 단점을 가지고 있다. 따라서 본 연구에서는 항목을 종합적으로 평가할 수 있는 정량적 지표를 설계하고, 항목들의 상대적 중요도를 파악할 수 있도록 항목들에 대한 가중치 부여한다. 또한 지표에서 얻어진 값으로 등급을 구분하고, 의사결정나무기법(decision tree)를 이용하여 해석력을 높이는 방법을 제시한다.

• Proceedings of the Korea Inteligent Information System Society Conference
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• 2001.01a
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• pp.97-108
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• 2001

Frauds detection is a difficult problem, requiring huge computer resources and complicated search activities Researchers have struggled with the problem. Even though a fee research approaches have claimed that their solution is much better than others, research community has not found 'the best solution'well fitting every fraud. Because of the evolving nature of the frauds. a novel and self-adapting method should be devised. In this research a new approach is suggested to solving frauds in insurance claims credit card transaction. Based on evolutionary computing approach, the method is itself self-adjusting and evolving enough to generate a new self of decision-makin rules. We believe that this new approach will provide a promising alternative to conventional ones, in terms of computation performance and classification accuracy.

• Proceedings of the Korea Inteligent Information System Society Conference
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• 2001.06a
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• pp.293-304
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• 2001

frauds detection is a difficult problem, requiring huge computer resources and complicated search activities. researchers have struggled with the problem. Even though a flew research approaches have claimed that their solution is much bettor than others, research community has not found 'the best solution'well fitting every fraud. Because of the evolving nature of the frauds, a Revel and self-adapting method should be devised. In this research a new approach is suggested to solving frauds in insurance claims and credit card transaction. Based on evolutionary computing approach, the method is itself self-adjusting and evolving enough to generate a new set of decision-making rules. We believe that this new approach will provide a promising alternative to conventional ones, in terms of computation performance and classification accuracy.

• Proceedings of the Korean Information Science Society Conference
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• 2006.10a
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• pp.484-489
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• 2006

Private Matching은 각기 다른 두 참여자 (two-party)가 가진 데이터의 교집합 (intersection)을 구하는 문제이다. Private matching은 보험사기 방지시스템 (insurance fraud detection system), 의료정보 검색, 항공기 탐승 금지자 목록 (Do-not-fly list) 검색 등에 이용될 수 있으며 다자간의 계산 (multiparty computation)으로 확장하면 전자투표, 온라인 게임 등에도 이용될 수 있다. 2004년 Freedman 등은 이 문제를 확률적 (probabilistic)으로 해결하는 프로토콜 (protocol) [1]을 제안하고 악의적인 공격자 (malicious adversary) 모델과 다자간 계산으로 확장하였다. 이 논문에서는 기존의 프로토콜을 결정적 (deterministic) 방법으로 개선하여 Semi-Honest 모델에서 결과의 정확성을 보장하는 한편, 이를 악의적인 공격자 모델에 확장하여 신뢰도와 연산속도를 향상시키는 새로운 프로토콜을 제안한다.

• Journal of KIISE:Computer Systems and Theory
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• v.34 no.10
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• pp.502-510
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• 2007

Private Matching is a problem of computing the intersection of private datasets of two parties. One could envision the usage of private matching for Insurance fraud detection system, Do-not-fly list, medical databases, and many other applications. In 2004, Freedman et at. [1] introduced a probabilistic solution for this problem, and they extended it to malicious adversary model and multi-party computation. In this paper, we propose a new deterministic protocol for private matching with perfect correctness. We apply this technique to adversary models, achieving more reliable and higher speed computation.