• 한국IT서비스학회지
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• 제6권2호
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• pp.1-18
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• 2007

Many researches have been done in insurance fraud as the amount and frequency of insurance fraud have been increasing continuously. In particular, the development of insurance fraud detection system using large database management techniques including data mining or link analysis based on visual method have been the main research topic in insurance fraud. However, this kinds of detection system were very ineffective to find unintentional insurance fraud happened by accident even though it was so good to find intentional and organized crime insurance fraud. Therefore, this research suggests insurance fraud as an ethical decision making and applies TPB(Theory of Planned Behavior) for the finding of reasons and prevention strategies of unintentional insurance fraud happened by accident. The results of research show that TPB is very appropriate model to explain the behavior of insurance fraud and that insurance agents force to do insurance fraud as affecting perceived behavior control. Therefore, education and pubic relations for insurance fraud are very effective for preventing insurance fraud and developing insurance service industry.

• 한국정보시스템학회지:정보시스템연구
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• 제18권4호
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• pp.41-57
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• 2009

Although financial information is a great influence upon determining of the group which use them, detection of management fraud and earning manipulation is a difficult task using normal audit procedures and corporate credit evaluation processes, due to the shortage of knowledge concerning the characteristics of management fraud, and the limitation of time and cost. These limitations suggest the need of systemic process for !he effective risk of earning manipulation for credit evaluators, external auditors, financial analysts, and regulators. Moot researches on management fraud have examined how various characteristics of the company's management features affect the occurrence of corporate fraud. This study examines financial characteristics of companies engaged in fraudulent financial reporting and suggests a model and system for detecting GAAP violations to improve reliability of accounting information and transparency of their management. Since the detection of management fraud has limited proven theory, this study used the detecting method of outlier(upper, and lower bound) financial ratio, as a real-field application. The strength of outlier detecting method is its use of easiness and understandability. In the suggested model, 14 variables of the 7 useful variable categories among the 76 financial ratio variables are examined through the distribution analysis as possible indicators of fraudulent financial statements accounts. The developed model from these variables show a 80.82% of hit ratio for the holdout sample. This model was developed as a financial outlier detecting system for a financial institution. External auditors, financial analysts, regulators, and other users of financial statements might use this model to pre-screen potential earnings manipulators in the credit evaluation system. Especially, this model will be helpful for the loan evaluators of financial institutes to decide more objective and effective credit ratings and to improve the quality of financial statements.

• 지능정보연구
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• 제20권3호
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• pp.93-108
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• 2014

기업 의사 결정 지원을 위하여 거래 데이터를 다양한 관점에서 분석하고 활용하려는 노력과 관심들이 증가하고 있다. 이러한 노력들은 고객 관리나 마케팅에만 국한되는 것이 아니라 부정행위에 대한 감시와 탐지를 목적으로도 다양한 분석 방안들이 연구되고 있다. 부정행위는 기술의 발전을 악용하여 다양한 형태로 진화하고 있으며, 이에 따라 목적에 맞는 부정탐지 방안 연구와 적용을 통하여 탐지 효용의 극대화를 위한 노력의 필요성이 증가하고 있다. 이러한 연구 동향의 일환으로 본 연구에서는 대용량 거래 데이터가 저장 관리되고 있는 국내 최대 농수산물 유통 시장의 2008년부터 2010년까지 상장예외품목의 거래 가격을 분석하여 부정 탐지 규칙을 도출하였으며, 전문가 검증을 통하여 도출 된 규칙의 신뢰성을 확보하였다. 본 연구의 주요 부정거래 분석 방안으로는 정상적인 데이터들은 발생 확률이 높은 반면에 특이한 데이터들의 발생 확률은 낮다고 가정하는 통계적 접근을 통한 이상치 식별 방안을 활용하였다. 이에 따라 부정거래 분석 별로 정의 된 Z-Score 값보다 클 경우 부정거래 탐지 대상이 된다. 다만 상장예외품목 거래의 경우 취급 가능한 중도매인의 수가 제한되어 있으며, 일반적인 상장품목의 거래보다 거래량이 적기 때문에 소수의 이상치가 품목의 평균에 미치는 영향이 크다. 그 예로 다른 소수의 중도매인들이 해당 품목을 정상적인 가격에 거래하였더라도, 특정한 중도매인 한 명이 지나치게 비정상적인 가격에 거래할 경우 모든 거래들이 부정거래로 탐지 될 가능성도 있다. 이러한 문제를 해결하기 위하여 기존의 Z-Score의 개념을 활용하여 수정된 Z-Score(Self-Eliminated Z-Score)를 사용하였다. 또한 부정 유형별 탐지 규칙 관리와 활용을 위한 시스템 프로토타입(prototype) 개발을 수행하였다. 이를 통하여 실제 부정거래 탐지 업무에 적용할 수 있는 효과적인 방안을 제시하였고, 농수산 유통시장의 공정성 및 투명성 확보를 위한 관리 감독의 기능 강화가 가능할 것이다.

• Industrial Engineering and Management Systems
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• 제9권2호
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• pp.141-156
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• 2010

Despite all attempts to prevent fraud, it continues to be a major threat to industry and government. Traditionally, organizations have focused on fraud prevention rather than detection, to combat fraud. In this paper we present a role mining inspired approach to represent user behaviour in Enterprise Resource Planning (ERP) systems, primarily aimed at detecting opportunities to commit fraud or potentially suspicious activities. We have adapted an approach which uses set theory to create transaction profiles based on analysis of user activity records. Based on these transaction profiles, we propose a set of (1) anomaly types to detect potentially suspicious user behaviour, and (2) scenarios to identify inadequate segregation of duties in an ERP environment. In addition, we present two algorithms to construct a directed acyclic graph to represent relationships between transaction profiles. Experiments were conducted using a real dataset obtained from a teaching environment and a demonstration dataset, both using SAP R/3, presently the predominant ERP system. The results of this empirical research demonstrate the effectiveness of the proposed approach.

• Asia pacific journal of information systems
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• 제28권4호
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• pp.308-319
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• 2018

This paper aims at providing valuable insights on Financial Fraud Detection on a mobile money transactional activity. We have predicted and classified the transaction as normal or fraud with a small sample and massive data set using Azure and Spark ML, which are traditional systems and Big Data respectively. Experimenting with sample dataset in Azure, we found that the Decision Forest model is the most accurate to proceed in terms of the recall value. For the massive data set using Spark ML, it is found that the Random Forest classifier algorithm of the classification model proves to be the best algorithm. It is presented that the Spark cluster gets much faster to build and evaluate models as adding more servers to the cluster with the same accuracy, which proves that the large scale data set can be predictable using Big Data platform. Finally, we reached a recall score with 0.73, which implies a satisfying prediction quality in predicting fraudulent transactions.

• 한국경영과학회:학술대회논문집
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• 한국경영과학회 2004년도 추계학술대회 및 정기총회
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• pp.68-98
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• 2004

Although the internet is useful for transferring information, Internet auction environments make fraud more attractive to offenders because the chance of detection and punishment are decreased. One of fraud is phantom transaction which is a colluding transaction by the buyer and seller to commit illegal discounting of credit card. They pretend to fulfill the transaction paid by credit card, without actual selling products, and the seller receives cash from credit card corporations. Then seller lends it out buyer with quite high interest rate whose credit score is so bad that he cannot borrow money from anywhere. The purpose of this study is to empirically investigate the factors to detect of the phantom transaction in online auction. Based up on the studies that explored behaviors of buyers and sellers in online auction, bidding numbers, bid increments, sellers' credit, auction length, and starting bids were suggested as independent variables. We developed an Internet-based data collection software agent and collect data on transactions of notebook computers each of which winning bid was over 1,000,000 won. Data analysis with logistic regression model revealed that starting bids, sellers' credit, and auction length were significant in detecting the phantom transaction.

• Journal of Preventive Medicine and Public Health
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• 제36권2호
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• pp.147-152
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• 2003

Objectives : To develop a Diagnosis-Related Group (DRG) fraud candidate detection method, using data mining techniques, and to examine the efficiency of the developed method. Methods ; The Study included 79,790 DRGs and their related claims of 8 disease groups (Lens procedures, with or without, vitrectomy, tonsillectomy and/or adenoidectomy only, appendectomy, Cesarean section, vaginal delivery, anal and/or perianal procedures, inguinal and/or femoral hernia procedures, uterine and/or adnexa procedures for nonmalignancy), which were examined manually during a 32 months period. To construct an optimal prediction model, 38 variables were applied, and the correction rate and lift value of 3 models (decision tree, logistic regression, neural network) compared. The analyses were peformed separately by disease group. Results : The correction rates of the developed method, using data mining techniques, were 15.4 to 81.9%, according to disease groups, with an overall correction rate of 60.7%. The lift values were 1.9 to 7.3 according to disease groups, with an overall lift value of 4.1. Conclusions : The above findings suggested that the applying of data mining techniques is necessary to improve the efficiency of DRG fraud candidate detection.

• Journal of Korea Trade
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• 제24권1호
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• pp.59-81
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• 2020

Purpose - This study analyzes the scope of due diligence and risks of banks and K-Sure in trade finance covered by EFF focusing on Moneual case, one of the latest and biggest trade finance fraud cases in Korea. Also, we suggest anti-fraud measures in trade finance on the part of banks and K-Sure in order to give them a desirable way of due diligence and reasonable risk management of export insurance. Design/methodology - Based on Moneual case of trade finance fraud, this study employs the methodology of an extended literature review and analysis of court decisions. Findings - Seoul High Court of Korea failed to decide whether K-Sure was wholly obliged to pay the insurance against the banks' EFF claims, but issued a compulsory mediation order, judging that both the banks and K-Sure were responsible by 50:50. The court may have judged that both the parties had lacked their due diligence in the trade finance. It is quite difficult for trade finance providers to manually investigate whether the transaction is suspected of trade finance fraud, so digitalization of trade finance which can facilitate the prevention and detection of trade fraud needs to be realized quickly. Since there has been no international rule available for open account trade finance up till now, clearly stipulated EFF terms on the exporter's genuine export obligation might have protected K-Sure from the disaster. Originality/value - This study investigates the due diligence of the banks and K-Sure in Moneual case which few researchers have considered, to the best of our knowledge. This study also suggests several practical methods (including block chain) to prevent complicating trade finance fraud amid increasing use of an open account, and further offers reasonable risk management of EFF employing international factoring rule which is also related to problematic open account trade finance.

• 디지털융복합연구
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• 제20권2호
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• pp.241-250
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• 2022

COVID-19 여파로 인한 비대면 서비스와 가정 재정 불안정성의 증가로 이륜차 보험사기 발생이 예상되고 있다. 이와 함께 보험사기 수법도 갈수록 교묘해지고 있다. 하지만 비대면 배달 수요와 연관된 이륜차 교통사고와 보험사기 적발 모형 관련 연구는 매우 미흡한 실정이다. 이에 본 연구는 보험사기의 표본 편중문제를 해결하기 위해 균형 랜덤포레스트 알고리즘을 이용하고 보험사기 조사 전문가의 정성적인 판단 기준을 반영한 변수를 모델에 포함하여 적용성을 향상시키며 적발력 높은 이륜차 보험사기 모형을 개발하고자 한다. 보험사기 적발 모형 개발 결과, 기존의 비균형 랜덤 포레스트 모형에 비해 균형 랜덤 포레스트가 보험 사기혐의자를 분류하는 데 있어 통계적으로 우수한 점을 확인할 수 있었다. 특히, 총 26개의 변수를 토대로 탐색적 변수 조합을 적용한 모형의 예측 성능이 가장 높았지만 일부 변수만을 사용한 확인적 모형의 예측 성능도 크게 떨어지지 않은 와중에, 정성적인 보험사기 전문가가 선정한 변수만을 사용한 확인적 모형은 예측력이 떨어지는 것을 확인하였다. 또한, 총 26개의 변수 중 운전자 성별, 연령, 운전자 피보험자 일치 여부, 미수선 청구금액, 대인보험금 등이 중요한 변수로 확인되어 이를 활용해 이륜차 보험사기 혐의자 선별을 위한 적극적인 대처가 필요해 보인다.

• 한국인터넷방송통신학회논문지
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• 제16권6호
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• pp.255-264
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• 2016

정보통신기술의 급속한 발전으로 경제활동 분야에서 큰 변화를 가져오고 있으며 혁신적으로 변화하고 있는 것은 전자상거래라고 할 수 있다. 더불어 전자금융사기의 방법도 나날이 진화하면서 피해사례도 함께 늘어나고 있다. 이에 따라 전자금융 이상거래에 대한 분석 및 탐지가 되고 있으나 여전히 피해가 발생되고 있는 상황이다. 본 연구에서는 금융환경, 금융 IT 환경, 금융 IT보안 환경과 법제도적인 변화의 특성을 분석하고 현재 금융기관에서 운영되는 이상금융거래 탐지시스템의 한계점을 보완하기 위하여 효과적인 전자금융 이상거래 분석 및 탐지 관리 체계와 외부기관과의 정보공유 및 개인정보 수집 및 활용에 대한 고려사항을 제안하고자 한다.