Optimal Auditing with Scoring: Theory and Application to Insurance Fraud
AbstractThis article makes a bridge between the theory of optimal auditing and the scoring methodology in an asymmetric information setting. Our application is meant for insurance claims fraud, but it can be applied to many other activities that use the scoring approach. Fraud signals are classified based on the degree to which they reveal an increasing probability of fraud. We show that the optimal auditing strategy takes the form of a "red flags strategy," which consists in referring claims to a special investigative unit (SIU) when certain fraud indicators are observed. The auditing policy acts as a deterrence device, and we explain why it requires the commitment of the insurer and how it should affect the incentives of SIU staffs. The characterization of the optimal auditing strategy is robust to some degree of signal manipulation by defrauders as well as to the imperfect information of defrauders about the audit frequency. The model is calibrated with data from a large European insurance company. We show that it is possible to improve our results by separating different groups of insureds with different moral costs of fraud. Finally, our results indicate how the deterrence effect of the audit scheme can be taken into account and how it affects the optimal auditing strategy.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoArticle provided by INFORMS in its journal Management Science.
Volume (Year): 55 (2009)
Issue (Month): 1 (January)
audit; scoring; insurance fraud; red flags strategy; fraud indicators; suspicion index; moral cost of fraud; deterrence effect; signal manipulation;
Other versions of this item:
- Dionne, Georges & Giuliano, Florence & Picard, Pierre, 2009. "Optimal auditing with scoring: theory and application to insurance fraud," MPRA Paper 18374, University Library of Munich, Germany.
- Georges Dionne & Florence Giuliano & Pierre Picard, 2005. "Optimal Auditing with Scoring Theory and Application to Insurance Fraud," Working Papers hal-00243026, HAL.
- D0 - Microeconomics - - General
- G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies
- C4 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Guillen, Montserrat & Manuel Artis, 1994.
"Count Data Models For A Credit Scoring System,"
021, Risk and Insurance Archive.
- Townsend, Robert M., 1988. "Information constrained insurance : The revelation principle extended," Journal of Monetary Economics, Elsevier, vol. 21(2-3), pages 411-450.
- Peter Ove Christensen, 2002. "Accounting Policies in Agencies with Moral Hazard and Renegotiation," Journal of Accounting Research, Wiley Blackwell, vol. 40(4), pages 1071-1090, 09.
- Dionne, G. & Gagne, R., 2000.
"Replacement Cost Endorsement and Opportunitic Fraud in Automobile Insurance,"
Ecole des Hautes Etudes Commerciales de Montreal-
00-01, Ecole des Hautes Etudes Commerciales de Montreal-Chaire de gestion des risques..
- Dionne, Georges & Gagne, Robert, 2002. " Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance," Journal of Risk and Uncertainty, Springer, vol. 24(3), pages 213-30, May.
- G. Dionne & R. Gagné, 2000. "Replacement Cost Endorsement and Opportunistic Fraud in Automobile Insurance," THEMA Working Papers 2000-06, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
- John Knowles & Nicola Persico & Petra Todd, 2001.
"Racial Bias in Motor Vehicle Searches: Theory and Evidence,"
Journal of Political Economy,
University of Chicago Press, vol. 109(1), pages 203-232, February.
- John Knowles & Nicola Persico & Petra Todd, . ""Racial Bias in Motor Vehicle Searches: Theory and Evidence''," CARESS Working Papres 99-06, University of Pennsylvania Center for Analytic Research and Economics in the Social Sciences.
- John Knowles & Nicola Persico & Petra Todd, 1999. "Racial Bias in Motor Vehicle Searches: Theory and Evidence," NBER Working Papers 7449, National Bureau of Economic Research, Inc.
- John Knowles & Nicola Persico & Petra Todd, . "Racial Bias in Motor Vehicle Searches: Theory and Evidence," Penn CARESS Working Papers 5940d5c4875c571776fb29700, Penn Economics Department.
- G. Dionne, 2000.
"The Empirical Measure of Information Problems with Emphasis on Insurance Fraud,"
THEMA Working Papers
2000-20, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
- Dionne, G., 2000. "The Empirical Measure of Information Problems with Emphasis on Insurance Fraud," Ecole des Hautes Etudes Commerciales de Montreal- 00-04, Ecole des Hautes Etudes Commerciales de Montreal-Chaire de gestion des risques..
- Georges Dionne & Robert Gagné, 2001. "Deductible Contracts Against Fraudulent Claims: Evidence From Automobile Insurance," The Review of Economics and Statistics, MIT Press, vol. 83(2), pages 290-301, May.
- Picard, Pierre, 1996. "Auditing claims in the insurance market with fraud: The credibility issue," Journal of Public Economics, Elsevier, vol. 63(1), pages 27-56, December.
- Townsend, Robert M., 1979.
"Optimal contracts and competitive markets with costly state verification,"
Journal of Economic Theory,
Elsevier, vol. 21(2), pages 265-293, October.
- Robert Townsend, 1979. "Optimal contracts and competitive markets with costly state verification," Staff Report 45, Federal Reserve Bank of Minneapolis.
- Crocker, Keith J & Tennyson, Sharon, 2002. "Insurance Fraud and Optimal Claims Settlement Strategies," Journal of Law and Economics, University of Chicago Press, vol. 45(2), pages 469-507, October.
- Nicola Persico, 2002. "Racial Profiling, Fairness, and Effectiveness of Policing," American Economic Review, American Economic Association, vol. 92(5), pages 1472-1497, December.
- Beneish, Messod D., 1997. "Detecting GAAP violation: implications for assessing earnings management among firms with extreme financial performance," Journal of Accounting and Public Policy, Elsevier, vol. 16(3), pages 271-309.
- M. Martin Boyer, 2004. "Overcompensation as a Partial Solution to Commitment and Renegotiation Problems: The Case of "Ex Post" Moral Hazard," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 71(4), pages 559-582.
- Mookherjee, Dilip & Png, Ivan, 1989. "Optimal Auditing, Insurance, and Redistribution," The Quarterly Journal of Economics, MIT Press, vol. 104(2), pages 399-415, May.
- Gale, Douglas & Hellwig, Martin, 1985. "Incentive-Compatible Debt Contracts: The One-Period Problem," Review of Economic Studies, Wiley Blackwell, vol. 52(4), pages 647-63, October.
- P. Picard, 1996.
"On the Design of Optimal Insurance Policies under Manipulation of Audit Cost,"
THEMA Working Papers
96-20, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
- Picard, Pierre, 2000. "On the Design of Optimal Insurance Policies under Manipulation of Audit Cost," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 41(4), pages 1049-71, November.
- Picard, Pierre, 1996. "On the design of optimal insurance policies under manipulation of audit cost," CEPREMAP Working Papers (Couverture Orange) 9605, CEPREMAP.
- Picard, P., 1996. "On the design of Optimal Insurance Policies Under Manipulation of Audit Cost," Papers 9620, Paris X - Nanterre, U.F.R. de Sc. Ec. Gest. Maths Infor..
- El Bachir Belhadji & George Dionne & Faouzi Tarkhani, 2000. "A Model for the Detection of Insurance Fraud*," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan, vol. 25(4), pages 517-538, October.
- Kofman, Fred & Lawarree, Jacques, 1993. "Collusion in Hierarchical Agency," Econometrica, Econometric Society, vol. 61(3), pages 629-56, May.
- Viaene, Stijn & Derrig, RA & Baesens, Bart & Dedene, Guido, 2002. "A comparison of state-of-the-art classification techniques for expert automobile insurance claim fraud detection," Open Access publications from Katholieke Universiteit Leuven urn:hdl:123456789/101074, Katholieke Universiteit Leuven.
- Dionne, G. & St-Michel, P. & Gibbens, A., 1993. "An Economic Analysis of Insurance Fraud," Cahiers de recherche 93010, Centre interuniversitaire de recherche en économie quantitative, CIREQ.
- Jean-Marc Bourgeon & Pierre Picard, 2012. "Fraudulent Claims and Nitpicky Insurers," Working Papers hal-00675106, HAL.
- Samohyl, Robert, 2012. "Audits and logistic regression, deciding what really matters in service processes: a case study of a government funding agency for research grants," MPRA Paper 41557, University Library of Munich, Germany.
- Matthias Lang & Achim Wambach, 2010. "The fog of fraud – mitigating fraud by strategic ambiguity," Working Paper Series of the Max Planck Institute for Research on Collective Goods 2010_24, Max Planck Institute for Research on Collective Goods.
- Dominic Spengler, 2012. "Endogenising Detection in an Asymmetric Penalties Corruption Game," Discussion Papers 12/20, Department of Economics, University of York.
- Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.
- Georges Dionne, 2012. "The Empirical Measure of Information Problems with Emphasis on Insurance Fraud and Dynamic Data," Cahiers de recherche 1233, CIRPEE.
- Georges Dionne & Kili C. Wang, 2011. "Does Opportunistic Fraud in Automobile theft Insurance Fluctuate with the Business Cycle ?," Cahiers de recherche 1121, CIRPEE.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Mirko Janc).
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.