• 보건행정학회지
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• 제28권2호
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• pp.186-193
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• 2018

Background: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. Methods: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. Results: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (-1.40%, p<0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, -0.33%; non-target organizations of same region, -0.19%; non-target organizations of other regions, -0.17%). Conclusion: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.

• 시큐리티연구
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• 제53호
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• pp.37-59
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• 2017

본 연구는 산업보안상 인적취약요소로 분류되는 조직구성원에 의한 업무부정행위의 정의와 발생원인, 방지대책 등에 대하여 문헌연구를 통해 고찰하고, 선행연구를 통해 드러난 부정행위의 행동적 발생징후들에 대하여 은행, 보험사, 증권사 등 국내 금융산업에 종사하고 있는 근로자들에게 설문자료를 수집하여 기술통계, 요인분석, 로지스틱 회귀분석 등을 실시하였다. 분석결과, 부정행위의 발생징후들은 '경제적 동기', '비경제적 동기' 두 가지 요인으로 분류되었으며, '과도한 주식투자'와 '빈번한 이사 등으로 생활환경의 불안정'의 두 징후에 대한 정확성 평가와 실제 부정행위의 적발 경험이 통계적으로 유의미하게 연관되어 있는 것으로 확인되었다. 또한 내 외부 제보에 의해서 업무부정행위가 가장 많이 적발되는 것으로 나타났다. 본 연구의 분석결과를 토대로 향후 금융산업에서 발생할 수도 있는 업무부정행위를 조기에 발견하여 피해규모를 최소화도록 일조하는 데 연구의 목적이 있다.

• 정보보호학회논문지
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• 제24권6호
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• pp.1243-1261
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• 2014

전자금융사기의 방법이 나날이 진화하면서 금전적 피해도 함께 늘어나고 있다. 이에 따라 전자금융사기 예방서비스가 시행되고 있으나 여전히 피해가 발생되고 있는 상황이다. 본 연구는 실제 피해사례를 중심으로 전자금융사기 예방서비스의 한계를 분석하여, 그 개선방안을 제안하는 것을 목적으로 수행되었다. 예방서비스 시행 전후의 사고 사례를 분석한 결과, '스마트폰 앱 이용 사기'와 '전화 및 문자 이용 사기' 유형이 서비스 시행 이후에도 건수가 증가하였고, '스마트폰 앱 이용 사기' 유형은 피해금액도 증가한 것으로 확인되었다. 본 연구는 각 세부사례 분석을 통해 식별된 전자금융 예방서비스의 한계점을 보완하기 위해 전자금융사기 예방서비스와 유사하게 현재 시행중인 예방 관련 서비스/제도 및 기술적 인프라의 도입과 활용을 중심으로, 전자금융사기 예방서비스 자체를 개선하고, 현재 시행/논의 중인 다양한 정책을 종심방어적 관점에서 종합적으로 연계하는 방안에 대해 고찰하였다.

• 무역상무연구
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• 제36권
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• pp.29-46
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• 2007

The fraud exception rule allows for the issuing bank to dishonor the claim if it the documents and transactions bear fraud though the documents presented are complied with the terms and conditions of the letter of credit. A question arises whether the fraud exception rule can apply to innocent beneficiary when fraud is made by 3rd party. United City Merchants v. Royal Bank of Canada showed a good example how to handle in case of innocent beneficiary. At this case House of Lord found that innocent beneficiary deserves payment applying nullity exception rule. I believe that the nullity exception rule is employed for the benefit of innocent beneficiary as far as the issuer and applicant get no actual damage by the 3rd party's fraudulent action which is shown on documents.

• 한국컴퓨터정보학회논문지
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• 제21권12호
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• pp.189-196
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• 2016

In this paper, I propose monetary penalties imposed on firms sanctioned by the Financial Supervisory Service for fraudulent financial reporting in accounting and auditing enforcement release(FSS-sanctioned fraud firms) should be disclosed to the notes of financial statement of the firms. Disclosing to the notes of financial statement for FSS-sanctioned fraud firms is an effective way to inform all the related parties of the information which affects the value of the corporation. Even though monetary penalties can affect the value of the firms, however, this study suggests that monetary penalties imposed on the fraud firms have a question on the effectiveness of the sanctions. In addition, this study finds that the magnitude of the market reactions between the fraud firms imposed by monetary penalties and the fraud firms imposed by non-monetary penalties has no difference. Based on these results, the information of FSS-sanctioned fraud firms should be disclosed to the notes of financial statements to have the market react effectively.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제16권3호
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• pp.1006-1027
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• 2022

In the crowdfunding market, various crowdfunding platforms can offer founders the possibilities to collect funding and launch someone's next campaign, project or events. Especially, healthcare crowdfunding is a field that is growing rapidly on health-related problems based on online platforms. One of the largest platforms, GoFundMe, has raised US$ 5 billion since 2010. Unfortunately, while providing crucial help to care for many people, it is also increasing risk of fraud. Using the largest platform of crowdfunding market, GoFundMe, we conduct an exhaustive search of detection on fraud from October 2016 to September 2019. Data sets are based on 6 main types of medical focused crowdfunding campaigns or events, such as cancer, in vitro fertilization (IVF), leukemia, health insurance, lymphoma and, surgery type. This study evaluated a detect of fraud process to identify fraud from non-fraud healthcare crowdfunding campaigns using various machine learning technics.

• 무역상무연구
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• 제34권
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• pp.55-74
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• 2007

The documentary credit has been functioning as an indispensable tool for making international commercial transactions safer throughout the world since ICC adopted the second revision of the Uniform Customs and Practices for Commercial Documentary Credits in 1962. Letter of Credit transaction should be cleared by the principle of the trust and integrity and vile partners sometimes make a fraud on the L/C by the misinterpretation of the documents. As there is no rule but no exception, exception from application of these principles is allowed. The fraud exception nile constitutes contracting out an application of basic principles, this rule should apply restrictively and in many authorities a court does not apply this rule to nominated bank, confirming bank, and bona fide holder of draft even if fraud is involved in L/C transactions. If not, we lose a lot of benefits from the credit as valuable commercial device through reservation of these principles to take a few benefits. So, We need to recognize that the fraud exception rule should be applied restrictively. Therefore, this study reviewed condition of application and exception from application of fraud exception rule in view of Cardozo's opinion, the Sztejn court, and UCC Sections-114(2).

• 한국전자거래학회지
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• 제20권2호
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• pp.141-153
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• 2015

인터넷 사용이 보편화되면서, 인터넷 직거래 사기사건이 크게 늘고 있다. 인터넷 사기에 대한 연구는 비교적 활성화되어 있는 반면, 개인 간 인터넷 직거래사기에 대한 연구결과는 많지 않다. 따라서 본 연구의 목적은 최근 급증하고 있는 인터넷 직거래 사기의 실태를 파악하고, 피해사례를 유형화하여 피해의 근본적 문제점을 살펴보고 결제수단의 보안 강화 및 법제 개선등 이러한 피해를 사전에 예방할 수 있는 보안대책을 제시하는 데 있다.

• 한국컴퓨터정보학회논문지
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• 제20권9호
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• pp.137-145
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• 2015

The Criminal Law of South Korea has needed to cope with new kinds of crimes such as the fraud by use of computer efficiently in a legislative way because the society has witnessed the rapid progress of the industrialization and informatization after established in 1953. As a result, the Criminal Law revised on December 29, 1995, created the regulations of the crimes related to fraud by use of computer, work disturbance, and secret piracy by using information processing units. The regulation stipulated in Clause 347, Article 2 of Criminal Law is the most typical one against the new crimes. However, the new regulation of fraud by use of computer, established and revised to supplement the lacking parts of the current rules of the punishment of fraud, limits its object to "any benefits to property." not to "property" itself, and so cannot achieve the purpose of the revision of the law. This paper aims to suggest a new legislative measure about the object of the regulation of fraud by use of computer to solve this kind of problem efficiently.

• The Journal of Asian Finance, Economics and Business
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• 제7권10호
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• pp.717-728
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• 2020

The objective of this study is to explore the whole process of fraud risk management strategies that should be implemented by the organizations. Secondly, this study discusses the governance issues that arise at each stage of the process. For the purpose of this study, a content analysis of previous literatures is used as a technique for gathering data. This process usually involves codifying qualitative and quantitative information into pre-defined categories in order to derive patterns in the presentation and reporting of information. Based on our content analysis, we found that the fraud risk management process should be made of at least five stages which are inculcating the culture of managing risks in an organization, identifying the risks, evaluating the risks, determining preventive actions and implementing and reviewing stages. Our extended analysis of the fraud risk management process finds that a lot of governance issues arise in the fraud risk management process that should be solved by regulators and companies in order to ensure that fraud risk management process is embedded as corporate culture, not merely as a process. Among them are how to create the risk culture in an organization and whether auditors and risk management committees identify risks from each available source.