• Proceedings of the Korean Operations and Management Science Society Conference
• /
• 2008.10a
• /
• pp.342-345
• /
• 2008

산재 발생 시 산재근로자는 근로복지공단을 통해서 각종 급여를 받게 된다. 본 논문은 심사 과정과 급여지급 후에 부정수급으로 판명된 산재 청구 건을 데이터 마이닝을 통해서 분석하여 부정수급의 유형을 발견하고자 한다. 이 연구에서는 서울관내 4개 지사에서 8년 동안(2000년$\sim$2007년)의 총 61,536명의 최초요양 신청을 한 산재근로자 자료를 대상으로 하였고, 종속변수에 영향을 미치는 8개의 독립변수를 선택해서 사용한다. 데이터 마이닝을 적용함에 있어서 가장 효율적인 허위 부정 탐지 모델을 만들기 위해 의사결정나무분석(Decision Tree)과 로지스틱 회귀분석(Logistic Regresion)등의 다양한 기법을 적용하여 결과를 비교분석 하고, 오분류 비용을 적용하여, 최적의 분류결정 값을 가지는 모델을 도출한다. 분석결과, 로지스틱 회귀분석이 산재보험 부정수급 유형 발견에 보다 효과적인 모델로 판명되었다. 또한 판별점(Cut-Off) 0.01로 했을 때 4개변수(요양기간, 업종형태, 의료기관, 재해발생형태)가 부정수급에 탐지하는데 영향력이 큰 변수로 선정되었다.

• Proceedings of the Korea Inteligent Information System Society Conference
• /
• 2001.06a
• /
• pp.293-304
• /
• 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
• /
• 2006.10a
• /
• pp.484-489
• /
• 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.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.42
• /
• pp.133-160
• /
• 2009

In International trade the buyer and seller are normally separated from on another not only by distance but also by differences in language and culture. It is rarely possible for the performance of obligations to be simultaneous and the performance of contracts therefore calls for trust in a situation in which the parties are unlikely to feel able to trust each other unless they have a longstanding and successful relationship. Thus the seller under an international contract of sale will not wish to surrender documents of title to goods to the buyer until he has at least an assurance of payment, and no buyer will wish to pay for goods until he has received them. A gap of distrust thus exists which is often bridged by the undertaking of an intermediary known and trusted by both parties who will undertake on his own liability to pay the seller the contract price in return for the documents of title and then pass the documents to the buyer in return for the reimbursement. This is a common explanation of the theory behind the documentary letter of credit in which the undertaking of a bank of international repute serves as a "guarantee" to each party that the other will perform his obligations. The independence principle, also referred to as the "autonomy principle", is at the core of letter of credit or bank guarantee law. This principle provides that the letter of credit or bank guarantee is independent of the underlying contractual commitment - that is, the transaction that the credit is intented to secure - between the applicant and the beneficiary ; the credit is also independent of the relationship between the bank and its customer, the applicant. The most important exception to the independence principle is the doctrine of fraud in the transaction. A strict interpretation of the rule that the guarantee is independent of the underlying transaction would lead to the conclusion that neither fraud nor manifest abuse of rights by the beneficiary would constitute an objection to payment. There is one major problem related to "Independent guarantees", namely abusive or unfair callings. The beneficiary may make an unfair calling under the guarantee. The countermeasure of beneficiary's unfair calling divided three cases. First, advance countermeasure namely by contract. In other words, when the formation of the contract, the parties must insert the Force Majeure Clause, Arbitration Clause to Contract, and clear statement to the condition for demand calling. Second, post countermeasure namely by court. Many countries, including the United States, authorize the courts to grant an order enjoining the issuer from paying or enjoining the beneficiary from receiving payment under the guaranty letter. Third, Export Insurance. For example, the Export Credit Guarantees Department is prepared, subject to certain conditions, to cover the risk of unfair calling. Of course, KEIC in Korea is cover the risk of the all things for guarantees. On international projects, contractor performance is usually guaranteed by either a standby letters of credit or Independent guarantee. These instruments will be care the parties.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.33
• /
• pp.191-219
• /
• 2007

Section 39(5) of Marine Insurance Act 1906 concerns the case where with the privity of the assured, the ship is sent to sea in an unseaworthy state. The underwriters argue that the assured had"blind-eye knowledge" of the particular respect in which the ship was unseaworthy. Blind-eye knowledge requires a conscious reason for blinding the eye. There must be at least a suspicion of a truth about which one do not want to know and which one refuse to investigate. What has caused greater difficulty is the broad provision in s.17 which appears to be unlimited in its scope. The expression "utmost good faith" appears to derive from the idea of uberrimae fidei, words which indeed appear in the sidenote. The concept of uberrima fides does not appear to have derived from civil law and it has been regarded as unnecessary in civilian systems. S.17 raises many questions. But only two of them are critical to the decision of the present appeal-the fraudulent claim question and the litigation question. It is however necessary to discuss them in the context of a consideration of the problematic character of s.17. In the Star Sea Case, for the defendants to succeed in their defence under this part of the case the defendants have to show that claim was made fraudulently. They have failed to obtain a finding of fraud. It is not enough that until part of the way through the trial the owners failed to disclose to the defendants would have wished to see in order to provide them with some, albeit inadequate, evidential support for their alleged defence under s.39(5). The defence under s.17 fails. The Purpose of this work is to analyze the Star Sea Case, and to explore problems of the MIA relating to the judgement of this case.

• Fire Science and Engineering
• /
• v.31 no.4
• /
• pp.119-127
• /
• 2017

This study analyzed the cause of car explosion that occurred in the riverside park. The car carrying a male driver and a female passenger was parked in the park and explosion occurred inside the car. After the explosion, the driver and the passenger got burned. When they went to the hospital by the 119 Rescue Service, they stated that the car was sprayed with thinner before they had a quarrel and the explosion occurred during their quarrel. However, after several days, they changed their statement. They said that gasoline in the plastic bottle was poured and ran into the cigarette lighter. They tried to pull the cigarette lighter but pushed it by mistake. Then explosion occurred. Because only the explosion by mistake could receive car insurance, whether the cause of explosion was intentional or not became an issue. The car exploded was carefully investigated and analyzed. The statement of the driver and passenger was analyzed in the aspect of fire science. As a result, it was demonstrated that this car explosion occurred by driver's intention.

• Applied Chemistry for Engineering
• /
• v.28 no.4
• /
• pp.490-494
• /
• 2017

With increasing the number of vehicles, the accident rate also goes up and the damaged vehicles should be painted as a final repair process. At the painting stage the solvent-based paint causes environmental problems. To overcome these problems waterborne refinish paint is frequently used recently. However, for waterborne refinish, the costs of insurance coverage are too expensive, and insurance reimbursement costs could be burdensome. Because of the high price of aquatic paint treatment, the service shop might charge the malicious service price. In this study, the surfactant of Surfynol 104, which is the component in the paint, was used as an indicator whether the vehicle was painted with waterborne paint. The specimen was quantitatively analyzed to contain 0.38% of the surfactant through the standard addition method with isotope substituted internal standard (IS) of fluranthene-d10 by curie point pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS).

• The Korean Society of Law and Medicine
• /
• v.21 no.1
• /
• pp.33-67
• /
• 2020

The hospitals that are owned by non-medical personnel result when non-medical personnel with resources conspire with newly graduated medical doctors who cannot afford the enormous amount of capital required at the beginning of the establishment of a medical institution. Such hospitals, though they may have met the external requirements as medical institutions, disrupt the medical market as it should be centered by medical personnels, In addition, such hospitals are causing a huge social problem as it is illegally receiving and reducing various benefits such as medical care benefits and subsidies from the government, resulting in a significant financial leak in the national health insurance. The illegality of the opening of a non-medical personnel hospital is so high that it nullifies the contractual arrangement for the establishment, imposes criminal penalties on all persons involved in the establishment under the Korean Medical Law, and imposes administrative sanctions on medical personnel. In case the hospital was aware of the illegality of its opening, but had applied to receive medical care benefits from the National Health Insurance Act and the Medical Care Act, such actions will result in the return of the benefits under the National Health Insurance Act and the Medical Care Assistance Act, subject to the penalty for the crime of fraud, and aggravated punishment for specific economic crimes based on the amount of gain, as well as civil liability for torts. In this study, we will examine the current status of the regulations on the non-medical personnel hospital and present the basis for future legislative directions by looking at the legal regulations and the attitude of the precedents.

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

• The Korean Society of Law and Medicine
• /
• v.14 no.2
• /
• pp.49-80
• /
• 2013

The Issuance of false medical certificates on Criminal Law or the Medical Service Act are frequently applied to the insurance fraud cases related with the medical certificate, prescriptions. The meaning of medical certificate is not defined on the crime of Issuance of false medical certificates, but considering the rule of Paragraph 1 of Article 17 of the Medical Service Act, which punishes drawing up the medical certificate by anyone except the doctor who has directly examined, and the principle of legality, the medical certificate applied with the crime of Issuance of false medical certificates should (1) include the judgment after current medical ex-amination, (2) be written for the purpose of verifying the health status and (3) have a style that can be recognizable as medical document usually written by doctors. In addition, since there have been many argues on the range of application of the Paragraph 1 of Article 17 of the Medical Service Act, which generally regulates various kinds of documents such as medical certificates, prescriptions and others, which have different purpose and characters, the range of application of the clause above is needed to be interpreted strictly.