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Optimal Auditing with Scoring Theory and Application to Insurance Fraud

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Author Info

  • Georges Dionne

    (HEC Montréal - HEC MONTRÉAL)

  • Florence Giuliano

    (EconomiX - CNRS : UMR7166 - Université de Paris X - Nanterre)

  • Pierre Picard

    (CECO - Laboratoire d'econometrie de l'école polytechnique - CNRS : UMR7657 - Polytechnique - X)

Abstract

Cet article établit une liaison entre la théorie de l'audit optimal et la méthodologie du scoring dans un contexte d'asymétrie d'information. L'application retenue concerne la fraude à l'assurance, mais la même approche peut être appliquée à d'autres activités qui utilisent le scoring. Nous montrons que la stratégie et l'audit optimal consistent à transmettre les demandes d'indemnité à une cellule antifraude lorsque certains indicateurs de fraude sont observés. Les indicateurs de fraude sont classés en fonction d'une probabilité de fraude croissante. Une telle stratégie demeure optimale lorsque la politique d'enquête est budgétairement contrainte. De plus, la politique d'audit agit comme un mécanisme de dissuasion et nous expliquons pourquoi elle nécessite un engagement de l'assureur et comment elle devrait affecter les incitations financières du personnel de la cellule antifraude. Le modèle est calibré avec les données d'un grand assureur européen. Nous calculons une valeur critique d'un indice de suspicion de fraude qui fournit un seuil au delà duquel toutes les demandes d'indemnité doivent être soumises à audit et nous évaluons le gain potentiel qui pourrait être dérivé de la politique d'audit optimal. Nous montrons qu'il est possible d'améliorer ces résultats en séparant différents groupes d'assurés avec des coûts psychologiques de fraude différents. Enfin nos résultats montrent comment l'effet de dissuasion peut être pris en compte et comment il affecte la stratégie optimale d'audit.

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Bibliographic Info

Paper provided by HAL in its series Working Papers with number hal-00243026.

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Date of creation: 2005
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Handle: RePEc:hal:wpaper:hal-00243026

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References

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  1. 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.
  2. Nahum D. Melumad & Dilip Mookherjee, 1989. "Delegation as Commitment: The Case of Income Tax Audits," RAND Journal of Economics, The RAND Corporation, vol. 20(2), pages 139-163, Summer.
  3. 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.
  4. Dionne, Georges & Artis, Manuel & Guillen, Montserrat, 1996. "Count data models for a credit scoring system," Journal of Empirical Finance, Elsevier, vol. 3(3), pages 303-325, September.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Mookherjee, Dilip & Png, Ivan, 1989. "Optimal Auditing, Insurance, and Redistribution," The Quarterly Journal of Economics, MIT Press, vol. 104(2), pages 399-415, May.
  10. 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.
  11. 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.
  12. Picard, Pierre, 1996. "On the design of optimal insurance policies under manipulation of audit cost," CEPREMAP Working Papers (Couverture Orange) 9605, CEPREMAP.
  13. 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.
  14. 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.
  15. Townsend, Robert M., 1988. "Information constrained insurance : The revelation principle extended," Journal of Monetary Economics, Elsevier, vol. 21(2-3), pages 411-450.
  16. Robert Townsend, 1979. "Optimal contracts and competitive markets with costly state verification," Staff Report 45, Federal Reserve Bank of Minneapolis.
  17. 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.
  18. 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.
  19. Nicola Persico, 2002. "Racial Profiling, Fairness, and Effectiveness of Policing," American Economic Review, American Economic Association, vol. 92(5), pages 1472-1497, December.
  20. 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.
  21. Kofman, Fred & Lawarree, Jacques, 1993. "Collusion in Hierarchical Agency," Econometrica, Econometric Society, vol. 61(3), pages 629-56, May.
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Citations

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Cited by:
  1. Georges Dionne, 2012. "The Empirical Measure of Information Problems with Emphasis on Insurance Fraud and Dynamic Data," Cahiers de recherche 1233, CIRPEE.
  2. Jean-Marc Bourgeon & Pierre Picard, 2012. "Fraudulent Claims and Nitpicky Insurers," Working Papers hal-00675106, HAL.
  3. 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.
  4. Dominic Spengler, 2012. "Endogenising Detection in an Asymmetric Penalties Corruption Game," Discussion Papers 12/20, Department of Economics, University of York.
  5. Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.
  6. 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.
  7. Georges Dionne & Kili C. Wang, 2011. "Does Opportunistic Fraud in Automobile theft Insurance Fluctuate with the Business Cycle ?," Cahiers de recherche 1121, CIRPEE.

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