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Insurance Fraud: Issues and Challenges

Author

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  • Stijn Viaene

    (Katholieke Universiteit Leuven (K.U. Leuven) and Vlerick Leuven Gent Management School, Belgium)

  • Guido Dedene

    (Department of Applied Economics of K.U. Leuven, Belgium and Faculty of Economic Sciences and Econometrics of the Universiteit van Amsterdam, The Netherlands)

Abstract

This article is devoted to the phenomenon of insurance fraud. We start by surveying the various forms of insurance fraud as well as its extent and cost. We proceed to analyse the problem as the product of motivation and opportunity, and address the complexities of fraud control. Finally, we provide a high-level overview of current anti-fraud activity. The Geneva Papers on Risk and Insurance (2004) 29, 313–333. doi:10.1111/j.1468-0440.2004.00290.x

Suggested Citation

  • Stijn Viaene & Guido Dedene, 2004. "Insurance Fraud: Issues and Challenges," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 29(2), pages 313-333, April.
    • Handle: RePEc:pal:gpprii:v:29:y:2004:i:2:p:313-333
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    References listed on IDEAS

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    Cited by:

    1. Ben Baumberg Geiger, 2016. "Benefit ‘myths’? The accuracy and inaccuracy of public beliefs about the benefits system," CASE Papers /199, Centre for Analysis of Social Exclusion, LSE.
    2. Reurink, Arjan, 2016. "Financial fraud: A literature review," MPIfG Discussion Paper 16/5, Max Planck Institute for the Study of Societies.
    3. Emmanuel Laffort & Nicolas Dufour, 2021. "Prise en compte de la fraude dans les organisations : comment libérer la parole ?," Post-Print hal-03336041, HAL.
    4. Sungkwol Park & Xiaoyong Zheng & Roderick M. Rejesus & Barry K. Goodwin, 2022. "Somebody's watching me! Impacts of the spot check list program in U.S. crop insurance," American Journal of Agricultural Economics, John Wiley & Sons, vol. 104(3), pages 921-946, May.
    5. Engström, Per & Hesselius, Patrik, 2007. "The information method - theory and application," Working Paper Series 2007:17, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    6. Nils Mahlow & Joël Wagner, 2016. "Evolution of Strategic Levers in Insurance Claims Management: An Industry Survey," Risk Management and Insurance Review, American Risk and Insurance Association, vol. 19(2), pages 197-223, September.
    7. Tajudeen Olalekan Yusuf, 2011. "Brokers' incentives and conflicts of interest in the control of opportunism," Journal of Risk Finance, Emerald Group Publishing, vol. 12(3), pages 168-181, May.
    8. Viaene, Stijn & Ayuso, Mercedes & Guillen, Montserrat & Van Gheel, Dirk & Dedene, Guido, 2007. "Strategies for detecting fraudulent claims in the automobile insurance industry," European Journal of Operational Research, Elsevier, vol. 176(1), pages 565-583, January.
    9. Lu-Ming Tseng & Yue-Min Kang, 2015. "Managerial Authority, Turnover Intention and Medical Insurance Claims Adjusters’ Recommendations for Claim Payments," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 40(2), pages 334-352, April.
    10. Haithem Zourrig & Jeongsoo Park, 2019. "The effects of cultural tightness and perceived unfairness on Japanese consumers’ attitude towards insurance fraud: the mediating effect of rationalization," Journal of Financial Services Marketing, Palgrave Macmillan, vol. 24(1), pages 21-30, June.
    11. Jing Ai & Patrick L. Brockett & Linda L. Golden & Montserrat Guillén, 2013. "A Robust Unsupervised Method for Fraud Rate Estimation," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 80(1), pages 121-143, March.
    12. Ming-Jyh Wang & Chieh-Hua Wen & Lawrence W Lan, 2010. "Modelling Different Types of Bundled Automobile Insurance Choice Behaviour: The Case of Taiwan*," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 35(2), pages 290-308, April.
    13. Renee Flasher & Melvin A. Lamboy-Ruiz, 2019. "Impact of Enforcement on Healthcare Billing Fraud: Evidence from the USA," Journal of Business Ethics, Springer, vol. 157(1), pages 217-229, June.
    14. Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.
    15. Jill M. Bisco & Kathleen A. McCullough & Charles M. Nyce, 2019. "Postclaim Underwriting And The Verification Of Insured Information: Evidence From The Life Insurance Industry," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 86(1), pages 7-38, March.
    16. Warren, Danielle E. & Schweitzer, Maurice E., 2021. "When weak sanctioning systems work: Evidence from auto insurance industry fraud investigations," Organizational Behavior and Human Decision Processes, Elsevier, vol. 166(C), pages 68-83.
    17. Katja Müller & Hato Schmeiser & Joël Wagner, 2016. "The impact of auditing strategies on insurers’ profitability," Journal of Risk Finance, Emerald Group Publishing, vol. 17(1), pages 46-79, January.
    18. Lu-Ming Tseng & Yue-Min Kang, 2014. "The influences of sales compensations, management stringency and ethical evaluations on product recommendations made by insurance brokers," Journal of Financial Regulation and Compliance, Emerald Group Publishing Limited, vol. 22(1), pages 26-42, February.
    19. Lu-Ming Tseng & Wen-Pin Su, 2014. "Insurance Salespeople's Attitudes towards Collusion: The Case of Taiwan’s Car Insurance Industry," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 39(1), pages 25-41, January.
    20. Galeotti, Marcello & Rabitti, Giovanni & Vannucci, Emanuele, 2020. "An evolutionary approach to fraud management," European Journal of Operational Research, Elsevier, vol. 284(3), pages 1167-1177.
    21. Arash Rashidian & Hossein Joudaki & Taryn Vian, 2012. "No Evidence of the Effect of the Interventions to Combat Health Care Fraud and Abuse: A Systematic Review of Literature," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-8, August.
    22. Emmanuel Laffort & Nicolas Dufour, 2020. "External Fraud Risk Management seen from Luhmann’s Systemic Perspective and a Tentative Reading of Healthcare Insurance Companies’ Measures through this Perspective," Post-Print hal-03336033, HAL.

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