• Convergence Security Journal
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• v.15 no.6_2
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• pp.79-87
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• 2015

In order to clearly recognize illegality of insurance crime, declaring the provisions on insurance crime is preferable. An insurance fraud differentiated from Configuration Requirements of general fraud should be established And differentiation in accordance with the act type of insurance crime the degree of organizational involvement is required. Also the introduction of civil sanctions and creation of additional punishment provision about Organized insurance fraud are required. To notice duplicate insurance when sign up life insurance, the revision of the provisions is required. To limit unnecessary long-term hospitalization, hospitalization standard is required. Introduction of private investigator is required as a method for endowing with investigation to the staff of insurance companies. By providing information sharing laws between relevant agencies including insurance companies and law enforcement agencies, the foundation of information database, and the introduction of SNA Techniques in the IFAS,, you can detect Organized collusion crime.

• 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 INTERNATIONAL COMMERCE & LAW REVIEW
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• v.53
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• pp.207-229
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• 2012

In IP 7 and LCCP 201, Law Commission considers the insured's duty of good faith after the formation of the contract. This article intends to review and analyse the legal implications of proposals in IP 7 and LCCP 201. The results of analysis are following. First, Law Commission propose to end the remedy of avoidance under MIA 1906 section 17, because avoidance of past claims is unprincipled, impractical and unnecessarily harsh. Secondly, LC proposes that an insured who makes a fraudulent claim should forfeit the whole claim which the fraud relates, but that the fraud should not invalidate previous and legitimate claims. Thirdly, LC proposes to introduce a statutory right for the insurer to claim damages for the reasonable, foreseeable costs of investigate a fraudulent claim in specific circumstances and that damages would be limited to those cases where the insurer can show an actual, net loss. Finally, LC provisionally propose that an express fraud clause should be upheld in business insurance, whereas in consumer insurance, any term which purports to give the insurer greater rights in relation to fraudulent claims that those set out in statute would be of no effect.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.41-69
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• 2012

First introduced in 1977, Korean health care system reached to national coverage in short period of time never seen before in any other countries, and rated as successful system protecting the health of the public at relatively low price. However, despite those positive evaluations, some of fraudulent medical organizations or pharmacies are hindering the sound development of the national health care system with meticulous false billing exaggerating the number of patients or the days of their treatment. To prevent aforementioned nursing home fraud and false billing, the misconduct should be punished as subject to the criminal law and severally punished for fines and payments which far exceed the expected amount of illicit gains as it is basically violation of criminal fraud, other than the forced return of illicit gains based on civil laws. Furthermore, the Health Insurance Review and Assessment Service should strengthen and complement the fraud investigators, the review process, and the professional training to raise the detection rates. It might also want to review ways to implement whistleblower rewarding system and rewards for evidences of healthcare fraud to overcome the limits of external review.

• 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.

• KSII Transactions on Internet and Information Systems (TIIS)
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• v.16 no.3
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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.

• Korean Security Journal
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• no.32
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• pp.151-176
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• 2012

Government organizations (including police, prosecutor, and Financial Supervisory Service) and programs to uncover or prevent from insurance crime are not well developed. However, insurance crime are increasing among not only private insurances such as life insurance, indemnity insurance, and auto insurance but also public insurances including national health insurance and industrial accident compensation insurance. The damages of crimes are serious in both economical and ethical perspectives. Insurance crime deteriorates a current account of insurance companies and the leakages due to insurance fraud worsen loss ratio. Consequently, insurance crime increases customers' costs of insurance. For this reason, insurance companies stated to establish Special Investigation Unit(SIU) to detect insurance crime and fraud by themselves. However, organizational and operational efficiencies are limited. The purpose of this study is to examine the relationship between work environment factors, perception of insurance crime and job satisfaction among Special Investigation Units. Therefore, this study investigated the perception of work environments of Special Investigation Units. In addition, this study examined how their work environments and general perception of insurance crime influence their job satisfaction. In order test the purpose of this study, reliability test, exploratory factor analysis(EFA), multiple regression were employed. The results of this study suggested that clarity of insurance company, distress/difficulty of resolve, compensation, perception of work pressure are statistically significant on jab satisfaction among Special Investigation Unit in South Korea. This exploratory study expected to contribute to understanding of Special Investigation Unit, and their insurance crime prevention system. The results from this analysis will be examined in light of previous findings and policy implications discussed.

• Transportation Technology and Policy
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• v.9 no.3
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• pp.13-18
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• 2012

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.77
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• pp.113-144
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• 2018

This study explores how to prevent the fraudulent export financing and its subsequent export insurance fraud in relation to O/A negotiation. Under the traditional letter of credit(L/C) transactions, the banks, as a negotiation bank, can extend trade financing to the exporters through negotiation of draft and/or shipping documents. Under the O/A transaction scheme, however, bank cannot ascertain existence of trade performance and it is much riskier to extend an advance financing to the exporters before the buyer sends confirmation of debt. In O/A negotiation. some exporters tried to fraud banks by falsifying the shipping documents and the size and gravity of this fraudulent export financing were huge. Therefore, this study examines the banking process in O/A-based trade financing, documents examination process, the negotiation of instruments, treatment of trade financing in export credit guarantee, most importantly, explores what could be the criteria for appropriate treatment of account receivable to insure the safe transfer of account receivable. To maximize the benefit for optimum trade financing, the Bank of Korea established several Trade Finance Rules (refers to "BOK Rules") requiring that commercial banks should maintain optimal credit limits(so called, 'the principle of optimal loan') to extend the trade finance. The K-sure post-shipment credit guarantee programs and short-term export insurance program(EFF)can also facilitate 'the principle of optimal loan' principle.

• Korean Security Journal
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• no.53
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• pp.37-59
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• 2017

This study aims to contribute to the early detection of occupational fraud in the Korean financial industry by analyzing fraud symptoms. Firstly, the definition, cause of occupational fraud, and fraud symptoms were discussed through literature review. Secondly, survey data were collected from the employees of the financial industry such as bank, insurance, and securities companies to conduct statistical analysis. The result of analysis showed that the symptoms of 'excessive stock investment' and 'unsettled life style' were statistically significant predictors of fraud detection experience. Plus, 'tips and complaints' were the most frequent method for detecting occupational fraud in the Korean financial industry. The financial institutions can minimize the loss of occupational fraud by early detection through educating their employees and vendors on these important symptoms of occupational fraud.