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Optimal auditing with scoring: theory and application to insurance fraud

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  • Dionne, Georges
  • Giuliano, Florence
  • Picard, Pierre

Abstract

This 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.

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Bibliographic Info

Paper provided by University Library of Munich, Germany in its series MPRA Paper with number 18374.

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Date of creation: Jan 2009
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Publication status: Published in Management Science 1.55(2009): pp. 58-70
Handle: RePEc:pra:mprapa:18374

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Related research

Keywords: Audit; scoring; insurance fraud; red flags strategy; fraud indicators; suspicion index; moral cost of fraud; deterrence effect; signal manipulation.;

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References

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  1. 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.
  2. 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.
  3. 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.
  4. Robert Townsend, 1979. "Optimal contracts and competitive markets with costly state verification," Staff Report 45, Federal Reserve Bank of Minneapolis.
  5. 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.
  6. 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.
  7. Picard, Pierre, 1996. "On the design of optimal insurance policies under manipulation of audit cost," CEPREMAP Working Papers (Couverture Orange) 9605, CEPREMAP.
  8. 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.
  9. Guillen, Montserrat & Manuel Artis, 1994. "Count Data Models For A Credit Scoring System," Working Papers 021, Risk and Insurance Archive.
  10. Townsend, Robert M., 1988. "Information constrained insurance : The revelation principle extended," Journal of Monetary Economics, Elsevier, vol. 21(2-3), pages 411-450.
  11. 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.
  12. Mookherjee, Dilip & Png, Ivan, 1989. "Optimal Auditing, Insurance, and Redistribution," The Quarterly Journal of Economics, MIT Press, vol. 104(2), pages 399-415, May.
  13. 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.
  14. Kofman, Fred & Lawarree, Jacques, 1993. "Collusion in Hierarchical Agency," Econometrica, Econometric Society, vol. 61(3), pages 629-56, May.
  15. Nicola Persico, 2002. "Racial Profiling, Fairness, and Effectiveness of Policing," American Economic Review, American Economic Association, vol. 92(5), pages 1472-1497, December.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
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Citations

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Cited by:
  1. Lang, Matthias & Wambach, Achim, 2013. "The fog of fraud – Mitigating fraud by strategic ambiguity," Games and Economic Behavior, Elsevier, vol. 81(C), pages 255-275.
  2. 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.
  3. Jean-Marc Bourgeon & Pierre Picard, 2012. "Fraudulent Claims and Nitpicky Insurers," Working Papers hal-00675106, HAL.
  4. Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.
  5. Georges Dionne, 2012. "The Empirical Measure of Information Problems with Emphasis on Insurance Fraud and Dynamic Data," Cahiers de recherche 1233, CIRPEE.
  6. Georges Dionne & Kili C. Wang, 2011. "Does Opportunistic Fraud in Automobile theft Insurance Fluctuate with the Business Cycle ?," Cahiers de recherche 1121, CIRPEE.
  7. Dominic Spengler, 2012. "Endogenising Detection in an Asymmetric Penalties Corruption Game," Discussion Papers 12/20, Department of Economics, University of York.
  8. Georges Dionne & Kili Wang, 2013. "Does insurance fraud in automobile theft insurance fluctuate with the business cycle?," Journal of Risk and Uncertainty, Springer, vol. 47(1), pages 67-92, August.

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