IDEAS home Printed from https://ideas.repec.org/a/eee/ejores/v284y2020i3p1167-1177.html
   My bibliography  Save this article

An evolutionary approach to fraud management

Author

Listed:
  • Galeotti, Marcello
  • Rabitti, Giovanni
  • Vannucci, Emanuele

Abstract

Building on several contributions to the analysis of insurance fraud, we propose a dynamical model of the fraudulence game, where three typologies of players interact: the insurance company, the fraudsters and the honest insured (who may be tempted to become dishonest), each one taking decisions on the basis of an adaptive strategy.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:ejores:v:284:y:2020:i:3:p:1167-1177
    DOI: 10.1016/j.ejor.2020.01.017
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0377221720300382
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.ejor.2020.01.017?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Zhixin Dai & Fabio Galeotti & Marie Claire Villeval, 2018. "Cheating in the Lab Predicts Fraud in the Field: An Experiment in Public Transportation," Management Science, INFORMS, vol. 64(3), pages 1081-1100, March.
    2. Tahir Ekin & Francesca Ieva & Fabrizio Ruggeri & Refik Soyer, 2018. "Statistical Medical Fraud Assessment: Exposition to an Emerging Field," International Statistical Review, International Statistical Institute, vol. 86(3), pages 379-402, December.
    3. Wang, Deshen & Chen, Bintong & Chen, Jing, 2019. "Credit card fraud detection strategies with consumer incentives," Omega, Elsevier, vol. 88(C), pages 179-195.
    4. J. V. Hansen & J. B. McDonald & W. F. Messier, Jr. & T. B. Bell, 1996. "A Generalized Qualitative-Response Model and the Analysis of Management Fraud," Management Science, INFORMS, vol. 42(7), pages 1022-1032, July.
    5. Anastasopoulos, Nikolaos P. & Anastasopoulos, Markos P., 2012. "The evolutionary dynamics of audit," European Journal of Operational Research, Elsevier, vol. 216(2), pages 469-476.
    6. 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.
    7. Georges Dionne & Florence Giuliano & Pierre Picard, 2009. "Optimal Auditing with Scoring: Theory and Application to Insurance Fraud," Management Science, INFORMS, vol. 55(1), pages 58-70, January.
    8. G. Dionne & F. Giuliano & P. Picard, 2002. "Optimal auditing for insurance fraud," THEMA Working Papers 2002-32, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
    9. Fabio Castelli & Marcello Galeotti & Giovanni Rabitti, 2019. "Financial Instruments for Mitigation of Flood Risks: The Case of Florence," Risk Analysis, John Wiley & Sons, vol. 39(2), pages 462-472, February.
    10. 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.
    11. Lensberg, Terje & Eilifsen, Aasmund & McKee, Thomas E., 2006. "Bankruptcy theory development and classification via genetic programming," European Journal of Operational Research, Elsevier, vol. 169(2), pages 677-697, March.
    12. Eling, Martin & Wirfs, Jan, 2019. "What are the actual costs of cyber risk events?," European Journal of Operational Research, Elsevier, vol. 272(3), pages 1109-1119.
    13. 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.
    14. Jörg Schiller, 2006. "The Impact of Insurance Fraud Detection Systems," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 73(3), pages 421-438, September.
    15. Carlos Corona & Ramandeep S. Randhawa, 2010. "The Auditor's Slippery Slope: An Analysis of Reputational Incentives," Management Science, INFORMS, vol. 56(6), pages 924-937, June.
    16. Georges Dionne (ed.), 2013. "Handbook of Insurance," Springer Books, Springer, edition 2, number 978-1-4614-0155-1, November.
    17. Yang, Fiona X. & Zhang, Rachel Q. & Zhu, Kaijie, 2017. "Should purchasing activities be outsourced along with production?," European Journal of Operational Research, Elsevier, vol. 257(2), pages 468-482.
    18. Bernard, C. & Vanduffel, S., 2014. "Mean–variance optimal portfolios in the presence of a benchmark with applications to fraud detection," European Journal of Operational Research, Elsevier, vol. 234(2), pages 469-480.
    19. Mitra, Sovan & Karathanasopoulos, Andreas & Sermpinis, Georgios & Dunis, Christian & Hood, John, 2015. "Operational risk: Emerging markets, sectors and measurement," European Journal of Operational Research, Elsevier, vol. 241(1), pages 122-132.
    20. Häger, David & Andersen, Lasse B., 2010. "A knowledge based approach to loss severity assessment in financial institutions using Bayesian networks and loss determinants," European Journal of Operational Research, Elsevier, vol. 207(3), pages 1635-1644, December.
    21. Justin J. Hopkins & Edward L. Maydew & Mohan Venkatachalam, 2015. "Corporate General Counsel and Financial Reporting Quality," Management Science, INFORMS, vol. 61(1), pages 129-145, January.
    22. Cummins, J David & Tennyson, Sharon, 1996. "Moral Hazard in Insurance Claiming: Evidence from Automobile Insurance," Journal of Risk and Uncertainty, Springer, vol. 12(1), pages 29-50, January.
    23. Phua, Clifton & Gayler, Ross & Lee, Vincent & Smith-Miles, Kate, 2009. "On the communal analysis suspicion scoring for identity crime in streaming credit applications," European Journal of Operational Research, Elsevier, vol. 195(2), pages 595-612, June.
    24. 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.
    25. Mark Cecchini & Haldun Aytug & Gary J. Koehler & Praveen Pathak, 2010. "Detecting Management Fraud in Public Companies," Management Science, INFORMS, vol. 56(7), pages 1146-1160, July.
    26. Bayerstadler, Andreas & van Dijk, Linda & Winter, Fabian, 2016. "Bayesian multinomial latent variable modeling for fraud and abuse detection in health insurance," Insurance: Mathematics and Economics, Elsevier, vol. 71(C), pages 244-252.
    27. Véronique Van Vlasselaer & Tina Eliassi-Rad & Leman Akoglu & Monique Snoeck & Bart Baesens, 2017. "GOTCHA! Network-Based Fraud Detection for Social Security Fraud," Management Science, INFORMS, vol. 63(9), pages 3090-3110, September.
    28. Leonard, Kevin J., 1995. "The development of a rule based expert system model for fraud alert in consumer credit," European Journal of Operational Research, Elsevier, vol. 80(2), pages 350-356, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Farbmacher, Helmut & Löw, Leander & Spindler, Martin, 2022. "An explainable attention network for fraud detection in claims management," Journal of Econometrics, Elsevier, vol. 228(2), pages 244-258.
    2. 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.
    3. Pierre Picard, 2012. "Economic Analysis of Insurance Fraud," Working Papers hal-00725561, HAL.
    4. Dionne, Georges, 2012. "The empirical measure of information problems with emphasis on insurance fraud and dynamic data," Working Papers 12-10, HEC Montreal, Canada Research Chair in Risk Management.
    5. Dionne, Georges & Harrington, Scott, 2017. "Insurance and Insurance Markets," Working Papers 17-2, HEC Montreal, Canada Research Chair in Risk Management.
    6. 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.
    7. Lammers, Frauke & Schiller, Jörg, 2010. "Contract design and insurance fraud: An experimental investigation," FZID Discussion Papers 19-2010, University of Hohenheim, Center for Research on Innovation and Services (FZID).
    8. 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.
    9. Frauke von Bieberstein & Jörg Schiller, 2018. "Contract design and insurance fraud: an experimental investigation," Review of Managerial Science, Springer, vol. 12(3), pages 711-736, July.
    10. Kerstin Fiederling & Jörg Schiller & Frauke von Bieberstein, 2018. "Can we Trust Consumers’ Survey Answers when Dealing with Insurance Fraud?," Schmalenbach Business Review, Springer;Schmalenbach-Gesellschaft, vol. 70(2), pages 111-147, May.
    11. Dionne, Georges & Wang, Kili, 2011. "Does opportunistic fraud in automobile theft insurance fluctuate with the business cycle?," Working Papers 11-4, HEC Montreal, Canada Research Chair in Risk Management.
    12. Bénédicte Coestier & Nathalie Fombaron, 2003. "L'audit en assurance," THEMA Working Papers 2003-41, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
    13. 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.
    14. M. Martin Boyer & Jörg Schiller, 2003. "Merging Automobile Insurance Regulatory Bodies: The Case of Atlantic Canada," CIRANO Working Papers 2003s-70, CIRANO.
    15. 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.
    16. 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.
    17. 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.
    18. Höppner, Sebastiaan & Baesens, Bart & Verbeke, Wouter & Verdonck, Tim, 2022. "Instance-dependent cost-sensitive learning for detecting transfer fraud," European Journal of Operational Research, Elsevier, vol. 297(1), pages 291-300.
    19. Chamal Gomes & Zhuo Jin & Hailiang Yang, 2021. "Insurance fraud detection with unsupervised deep learning," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 88(3), pages 591-624, September.
    20. Yankol-Schalck, Meryem, 2022. "The value of cross-data set analysis for automobile insurance fraud detection," Research in International Business and Finance, Elsevier, vol. 63(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:ejores:v:284:y:2020:i:3:p:1167-1177. See general information about how to correct material in RePEc.

    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 CitEc recognized a bibliographic reference but did not link an item in RePEc 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 RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/eor .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.