Testing assumptions about naivety in insurance fraud

Abstract

Despite the recognition that traditional methods of fighting the rising and pressing crime of insurance fraud are ineffective, much attention in the process of its detection is still paid to the characteristics of false claims and of people submitting them. Although there is some research looking into the assumptions insurance companies hold about these characteristics, the question of the general public knowledge about them has been rather neglected. This appears unjustified in light of the fact that it is ‘the average’ opportunistic driver most likely to lie about their loss. The results of this project, employing the method of thematic analysis, whereby the narratives of 25 male drivers are examined, challenge the correctness of corporate assumptions about what the layman driver could know about insurance fraud.     

How the detection of insurance fraud succeeds and fails

Abstract

Insurance fraud is a serious and growing problem, and there is widespread recognition that traditional approaches to tackling fraud are inadequate. Studies of insurance fraud have typically focused upon identifying characteristics of fraudulent claims and claimants, and this focus is apparent in the current wave of forensic and data-mining technologies for fraud detection. An alternative approach is to understand and then optimize existing practices in the detection of fraud. We report an ethnographic study that explored the nature of motor insurance fraud-detection practices in two leading insurance companies. The results of the study suggest that an occupational focus on the practices of fraud detection can complement and enhance forensic and data-mining approaches to the detection of potentially fraudulent claims.     

Internet auction fraud: The evolving nature of online auctions criminality and the mitigating framework to address the threat

Online auctions have emerged as one of the popular segments of e-commerce. The popularity of this technology-aided business model is evidenced by the continuous growth of eBay and other e-auction markets. However, this growth of online auctions has also led to a corresponding rise in deception and online criminal activity. This paper presents the findings of an original experiment undertaken to examine the evolving criminality associated with eBay auctions. The article examines eBay’s existing fraud prevention framework and evaluate its effectiveness in mitigating the risk. The research has identified foundation of eBay’s fraud problem - the inability of eBay’s fraud prevention architecture to identify and eliminate rogue traders with obscure identity and questionable reputation. The authors have proposed a proactive and holistic e-fraud prevention typology to enhance trader’s authentication to fight online auction fraud.     

Dating hot spot to fraud hot spot: Targeting the social characteristics of romance fraud victims in England and Wales

Research Summary

We found that romance fraud was rising year-on-year across every region in England and Wales, increasing 55% during the 3 years between October 2018 and October 2021. Fifty percent of all the romance fraud victims in the period resided in 17% of the places where romance fraud had occurred. A total of 439 locations (outward postcode areas) were identified as the “power few” in the first year of the data set. Of these 439 locations, 162 of them recurred in both of the following years, becoming chronic “hot spot” locations containing more than one in six of all reported romance fraud victims. The demography of victims in repeat locations differed considerably, but hot spots were more frequently predominantly populated by less affluent populations.

Policy Implications

We conclude that the current national one-size-fits-all fraud prevention approach may not be the most efficient or effective way to reach those victims who most require crime prevention advice. The National Fraud Intelligence Bureau, based in the City of London Police, could adopt a tailored approach to providing preventative information to local police forces based on the year-to-year patterns in crime and the associated intelligence provided by sociodemographic data sources such as Acorn.     

New directions in policing fraud: The emergence of the counter fraud specialist in the United Kingdom

Fraud and corruption in the public sector have become issues of increasing importance for the government in the United Kingdom. Numerous initiatives have emerged ranging from high profile publicity campaigns against benefit fraud and tax evasion to the establishment of specialist bodies, such as the NHS Counter Fraud and Security Management Service (NHSCFSMS). One of the most interesting developments, however, has been the emergence of the ‘counter fraud specialist (CFS)’ across central and local government, as well as the private sector. These are specially trained civilian personnel who are tasked to prevent, investigate and secure sanctions against fraudsters. They undertake common training packages and are accredited by the Counter Fraud Professional Accreditation Board (CFPAB). This paper first outlines the emergence of the CFS; then draws upon the results of recent survey data to discuss some of their characteristics. The paper also considers some of the main issues raised by the growth of the CFS including the possible emergence of an embryonic ‘fraud police’, the indirect ‘load shedding’ of fraud investigation and the governance of this new breed of policing personnel.     

Examining the risk reduction strategies of actors in online criminal markets

Research examining offender risk reduction strategies within illicit markets focus primarily on those operating in the real world for drugs and stolen goods. Few have considered the strategies that may be used by individuals in virtual illicit markets that are hidden from public view. This study addresses this gap through a grounded theory analysis of posts from 10 Russian and three English language web forums selling stolen data to engage in identity theft and fraud. The findings indicate that buyers employ multiple strategies to reduce their risk of loss from unreliable vendors, along with resources provided by forum administrators to manage relationships between participants. The implications of this study for law enforcement and offender decision-making research are also discussed.     

Uncovering the Iceberg: Mandating the measurement of fraud in the United Kingdom

Having regard to the impact of the credit crunch on fraud, the 19% average cuts in public spending and the wide disparities in fraud loss data, this article will argue for the mandating of fraud measurement through the introduction of legislation in the United Kingdom. The proposed statute applies to both the public and private sectors and incorporates minimum standards of measurement accuracy and the publication of findings and subsequent reduction strategies. In support of this contention this paper offers empirical evidence provided by the United States (US) Improper Payments Information Act of 2002. Further options for change are also presented including developing the role of the National Audit Office and the creation of an infrastructure for knowledge management through the sharing of best practice.     

欺诈骗取医保基金风险防范的国际比较

采取文献分析法梳理国内外欺诈骗取医保基金风险防范的发展及现况,总结和比较打击欺诈骗保对策,以期为我国提供有价值的参考和建议.欺诈骗保行为的表现形式及成因多样,我国可借鉴国际经验,首要是完善相关法律并成立专门机构,利用大数据技术等手段,加强对医疗服务提供方和需求方的监管.     

关于网络购物纠纷解决的调查与思考

随着网络购物的兴起,网络购物纠纷也日益增多,而且网络购物纠纷解决起来往往困难重重。因此,只有加强道德建设和法制教育,营造一个有利于纠纷解决的道德和法制环境,构建完善的多元化网络购物纠纷解决机制,才能更好地解决网络购物纠纷,促进我国经济的进一步发展。     

《鹿特丹规则》对海上保险及相关法律规则的影响

《鹿特丹规则》的条文变化,表面上看是船方与货方权利与义务的再分配,但最终影响的还是船货双方背后的海上货物运输相关的各种保险,以及保险人之间风险和利益的分配。从保险人角度出发,对货运险和保赔险在新的公约体系下可能受到的影响进行分析,并提出合理建议。     

医疗责任保险的思考

大力发展医疗责任保险,对医疗执业过失给患者造成的损害进行充分赔偿,在保障患者和医疗机构及其医务人员的合法权益,优化医疗环境和医疗公共秩序方面有重要的促进作用。由于我国医院主体是公立医院,侵权法人身损害赔偿相对于综合医院尚未到重大程度,并且综合性医院每年发生的医疗过失案件基本确定,选择满足面临危险的医院财务安全需要的医疗责任保险模式,如医疗责任保险信托等,才能促进医疗责任保险的发展。实践表明,商业性医疗责任保险不宜成为我国医疗责任保险的主体。建立独立的医疗过失纠纷调解鉴定机构,才能保证医疗责任保险顺利开展。     

分期付款购车保证保险基本法律问题探析

保证保险不同于信用保险和保证担保,它在分期付款购车中的应用值得认真探讨。     

保险投资高级管理人员的勤勉义务研究

近年来,保险投资出现的问题层出不穷,保险资金运用不当导致保险资金的安全性降低,从而影响保险公司的稳定经营,也影响了保险的社会职能的发挥。本文立足于对保险投资的运用主体即保险投资高级管理人员在运用保险资金时的勤勉义务进行研究,加强保险投资高级管理人员的责任,使之在决定保险资金的运用时做到勤勉、谨慎,降低保险资金运用的风险。     

保险诈骗罪若干疑难问题探究

有关保险诈骗罪的主体争议:冒名骗赔的行为应定性为保险诈骗罪;隐名的投保人、被保险人可以成为保险诈骗罪的主体;保险人、保险经纪人、保险代理人诈骗投保人、被保险人、受益人的应定性为诈骗罪。虚构保险标的的表现:虚构根本不存在的保险标的;恶意超额保险;恶意重复保险;虚构保险利益;将不合格的标的虚构为合格的保险标的;事后保险。内外勾结共同骗取保险金的行为应一律认定为职务侵占罪或者贪污罪。     

Problems in expert deception detection and the risk of false confessions: no proof to the contrary in Levine et al. (2014)

Lie-detection research has shown that observers who rely on nonverbal cues or on verbal cues correctly classify on average 54% of truth tellers and liars. In addition, over the years, countless numbers of innocent people have made false confessions and, in analysing the problem, researchers have implicated both a suspect's vulnerability and the persuasive influence of certain police interrogation tactics. Levine et al. (2014) aim to contribute to these vast bodies of literature by reporting two studies purportedly showing that expert interviewers – when they are permitted to question interviewees – can achieve almost perfect accuracy without eliciting false confessions. We argue that theoretical and methodological aspects of these studies undermine the reliability and validity of the data reported, that as a result the studies do not contribute to the scientific literatures on lie detection and false confessions in any meaningful way, and that the results are dangerously misleading.     

海上保险代位求偿权之民法法源研究

针对《中华人民共和国保险法》和《中华人民共和国海商法》下就海上保险代位求偿权的相关法律规定,和保险代位求偿实务中出现的具体问题,采取定性分析法,提出在中国民商合一的立法体制下,保险代位求偿制度是民法中“公平原则”与保险法“补偿愿则”所奥合而成的必然产物,其民事本质为法定的债权转移。在该定性的前提下,对中国现行立法中的相关规定加以解释梳理,结合司法实践对保险代位求偿制度在英美法系和大陆法系下的不同进行比较分析,并从民法的角度对该制度加以完善,以求解决实践中可能出现的问题。     

海上保险及其立法起源考

海上保险及其立法的起源是海上贸易发展史以及海法史的重要组成部分。通过对海上保险以及海法历史著作的研究，认为现代意义上的海上保险起源于船货抵押借款制度并在13世纪的意大利经过“假借贷”的过渡发展为现代意义上的海上保险。在海上保险立法方面，有关船货抵押借款制度的法律规定可被视海上保险立法的萌芽，而现代海上保险的立法则开端于14世纪的地中海地区，并且各地区或国家的早期海上保险立法存在着很大的相似性。对于中国来说，海上保险完全是一个舶来品，而中国海上保险事业真正开始有法可依是在新中国成立后。     

论油污应属巨灾保险承保对象

油污符合巨灾保险承保对象所具有的损失发生巨大性、风险发生概率低、风险预测难度大和风险难以分散的识别标准,应属于巨灾保险承保对象.油污巨灾保险具有公共产品属性、石油利益的获得者具有广泛性、侵权损害赔偿责任呈现社会化分担趋势,故政府应当作为油污巨灾保险的投保人.将油污纳入巨灾保险体系中,有助于丰富油污保险类型,构建油污巨灾保险与普通油污保险二元并列的局面,以社会力量督促石油行业提高安全生产力度,并达到弥补普通油污保险、油污基金、政府救济等其他油污灾后救济制度缺陷的目标.