• Journal of Information Technology Services
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• v.6 no.2
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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.

• The Journal of Information Systems
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• v.18 no.4
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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.

• Journal of Intelligence and Information Systems
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• v.20 no.3
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• pp.93-108
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• 2014

To support business decision making, interests and efforts to analyze and use transaction data in different perspectives are increasing. Such efforts are not only limited to customer management or marketing, but also used for monitoring and detecting fraud transactions. Fraud transactions are evolving into various patterns by taking advantage of information technology. To reflect the evolution of fraud transactions, there are many efforts on fraud detection methods and advanced application systems in order to improve the accuracy and ease of fraud detection. As a case of fraud detection, this study aims to provide effective fraud detection methods for auction exception agricultural products in the largest Korean agricultural wholesale market. Auction exception products policy exists to complement auction-based trades in agricultural wholesale market. That is, most trades on agricultural products are performed by auction; however, specific products are assigned as auction exception products when total volumes of products are relatively small, the number of wholesalers is small, or there are difficulties for wholesalers to purchase the products. However, auction exception products policy makes several problems on fairness and transparency of transaction, which requires help of fraud detection. In this study, to generate fraud detection rules, real huge agricultural products trade transaction data from 2008 to 2010 in the market are analyzed, which increase more than 1 million transactions and 1 billion US dollar in transaction volume. Agricultural transaction data has unique characteristics such as frequent changes in supply volumes and turbulent time-dependent changes in price. Since this was the first trial to identify fraud transactions in this domain, there was no training data set for supervised learning. So, fraud detection rules are generated using outlier detection approach. We assume that outlier transactions have more possibility of fraud transactions than normal transactions. The outlier transactions are identified to compare daily average unit price, weekly average unit price, and quarterly average unit price of product items. Also quarterly averages unit price of product items of the specific wholesalers are used to identify outlier transactions. The reliability of generated fraud detection rules are confirmed by domain experts. To determine whether a transaction is fraudulent or not, normal distribution and normalized Z-value concept are applied. That is, a unit price of a transaction is transformed to Z-value to calculate the occurrence probability when we approximate the distribution of unit prices to normal distribution. The modified Z-value of the unit price in the transaction is used rather than using the original Z-value of it. The reason is that in the case of auction exception agricultural products, Z-values are influenced by outlier fraud transactions themselves because the number of wholesalers is small. The modified Z-values are called Self-Eliminated Z-scores because they are calculated excluding the unit price of the specific transaction which is subject to check whether it is fraud transaction or not. To show the usefulness of the proposed approach, a prototype of fraud transaction detection system is developed using Delphi. The system consists of five main menus and related submenus. First functionalities of the system is to import transaction databases. Next important functions are to set up fraud detection parameters. By changing fraud detection parameters, system users can control the number of potential fraud transactions. Execution functions provide fraud detection results which are found based on fraud detection parameters. The potential fraud transactions can be viewed on screen or exported as files. The study is an initial trial to identify fraud transactions in Auction Exception Agricultural Products. There are still many remained research topics of the issue. First, the scope of analysis data was limited due to the availability of data. It is necessary to include more data on transactions, wholesalers, and producers to detect fraud transactions more accurately. Next, we need to extend the scope of fraud transaction detection to fishery products. Also there are many possibilities to apply different data mining techniques for fraud detection. For example, time series approach is a potential technique to apply the problem. Even though outlier transactions are detected based on unit prices of transactions, however it is possible to derive fraud detection rules based on transaction volumes.

• Industrial Engineering and Management Systems
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• v.9 no.2
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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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• v.28 no.4
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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.

• Proceedings of the Korean Operations and Management Science Society Conference
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• 2004.10a
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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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• v.36 no.2
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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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• v.24 no.1
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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.

• Journal of Digital Convergence
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• v.20 no.2
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• pp.241-250
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• 2022

Due to the COVID-19 pandemic, with increased 'untact' services and with unstable household economy, the bike insurance fraud is expected to surge. Moreover, the fraud methodology gets complicated. However, the fraud detection model for bike insurance is absent. we deal with the issue of skewed class distribution and reflect the criterion of fraud detection expert. We utilize a balanced random-forest algorithm to develop an efficient bike insurance fraud detection model. As a result, while the predictive performance of balanced random-forest model is superior than it of non-balanced model. There is no significant difference between the variables used by the experts and the confirmatory models. The important variables to detect frauds are turned out to be age and gender of driver, correspondence between insured and driver, the amount of self-repairing claim, and the amount of bodily injury liability.

• The Journal of the Institute of Internet, Broadcasting and Communication
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• v.16 no.6
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• pp.255-264
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• 2016

Due to the development of information and communication technology, the great change on economics has grown and the biggest change is the e-commerce. With the methods of electronic financial frauds becoming advanced, reported phishing incidents have greatly increased. The Fraud Detection System(hereafter FDS) has taken effect to prevent electronic financial frauds, but economic losses still occurring. This Paper aims to analyze the financial environment, financial information technology environment, financial information technology security environment and some features of the institutional changes. In order to supplement the defect of FDS, it gives some recommendations for the improvement of the effective FDS Management System and information sharing on frauds with some public institution and a major consideration for collection or utilization of personal information.