• Title/Summary/Keyword: insurance fraud detection

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An Evolutionary Computing Approach to Building Intelligent Frauds Detection System

  • Kim, Jung-Won;Peter Bentley;Chol, Jong-Uk;Kim, Hwa-Soo
    • Proceedings of the Korea Inteligent Information System Society Conference
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    • 2001.01a
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    • pp.97-108
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    • 2001
  • Frauds detection is a difficult problem, requiring huge computer resources and complicated search activities Researchers have struggled with the problem. Even though a fee research approaches have claimed that their solution is much better than others, research community has not found 'the best solution'well fitting every fraud. Because of the evolving nature of the frauds. a novel and self-adapting method should be devised. In this research a new approach is suggested to solving frauds in insurance claims credit card transaction. Based on evolutionary computing approach, the method is itself self-adjusting and evolving enough to generate a new self of decision-makin rules. We believe that this new approach will provide a promising alternative to conventional ones, in terms of computation performance and classification accuracy.

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An Evolutionary Computing Approach to Building Intelligent Frauds Detection Systems

  • Kim, Jung-Won;Peter Bentley;Park, Jong-Uk
    • Proceedings of the Korea Inteligent Information System Society Conference
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    • 2001.06a
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    • pp.293-304
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    • 2001
  • frauds detection is a difficult problem, requiring huge computer resources and complicated search activities. researchers have struggled with the problem. Even though a flew research approaches have claimed that their solution is much bettor than others, research community has not found 'the best solution'well fitting every fraud. Because of the evolving nature of the frauds, a Revel and self-adapting method should be devised. In this research a new approach is suggested to solving frauds in insurance claims and credit card transaction. Based on evolutionary computing approach, the method is itself self-adjusting and evolving enough to generate a new set of decision-making rules. We believe that this new approach will provide a promising alternative to conventional ones, in terms of computation performance and classification accuracy.

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A Study on the Fraud Detection of Industrial Accident Compensation Insurance (산재보험 부정수급 식별모형에 관한 연구)

  • Ham, Seung-O;Hong, Jeong-Sik
    • Proceedings of the Korean Operations and Management Science Society Conference
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    • 2008.10a
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    • pp.342-345
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    • 2008
  • 산재 발생 시 산재근로자는 근로복지공단을 통해서 각종 급여를 받게 된다. 본 논문은 심사 과정과 급여지급 후에 부정수급으로 판명된 산재 청구 건을 데이터 마이닝을 통해서 분석하여 부정수급의 유형을 발견하고자 한다. 이 연구에서는 서울관내 4개 지사에서 8년 동안(2000년$\sim$2007년)의 총 61,536명의 최초요양 신청을 한 산재근로자 자료를 대상으로 하였고, 종속변수에 영향을 미치는 8개의 독립변수를 선택해서 사용한다. 데이터 마이닝을 적용함에 있어서 가장 효율적인 허위 부정 탐지 모델을 만들기 위해 의사결정나무분석(Decision Tree)과 로지스틱 회귀분석(Logistic Regresion)등의 다양한 기법을 적용하여 결과를 비교분석 하고, 오분류 비용을 적용하여, 최적의 분류결정 값을 가지는 모델을 도출한다. 분석결과, 로지스틱 회귀분석이 산재보험 부정수급 유형 발견에 보다 효과적인 모델로 판명되었다. 또한 판별점(Cut-Off) 0.01로 했을 때 4개변수(요양기간, 업종형태, 의료기관, 재해발생형태)가 부정수급에 탐지하는데 영향력이 큰 변수로 선정되었다.

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Deterministic Private Matching with Perfect Correctness (정확성을 보장하는 결정적 Private Matching)

  • Hong, Jeong-Dae;Kim, Jin-Il;Cheon, Jung-Hee;Park, Kun-Soo
    • Proceedings of the Korean Information Science Society Conference
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    • 2006.10a
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    • pp.484-489
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    • 2006
  • Private Matching은 각기 다른 두 참여자 (two-party)가 가진 데이터의 교집합 (intersection)을 구하는 문제이다. Private matching은 보험사기 방지시스템 (insurance fraud detection system), 의료정보 검색, 항공기 탐승 금지자 목록 (Do-not-fly list) 검색 등에 이용될 수 있으며 다자간의 계산 (multiparty computation)으로 확장하면 전자투표, 온라인 게임 등에도 이용될 수 있다. 2004년 Freedman 등은 이 문제를 확률적 (probabilistic)으로 해결하는 프로토콜 (protocol) [1]을 제안하고 악의적인 공격자 (malicious adversary) 모델과 다자간 계산으로 확장하였다. 이 논문에서는 기존의 프로토콜을 결정적 (deterministic) 방법으로 개선하여 Semi-Honest 모델에서 결과의 정확성을 보장하는 한편, 이를 악의적인 공격자 모델에 확장하여 신뢰도와 연산속도를 향상시키는 새로운 프로토콜을 제안한다.

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Deterministic Private Matching with Perfect Correctness (정확성을 보장하는 결정적 Private Matching)

  • Hong, Jeong-Dae;Kim, Jin-Il;Cheon, Jung-Hee;Park, Kun-Soo
    • Journal of KIISE:Computer Systems and Theory
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    • v.34 no.10
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    • pp.502-510
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    • 2007
  • Private Matching is a problem of computing the intersection of private datasets of two parties. One could envision the usage of private matching for Insurance fraud detection system, Do-not-fly list, medical databases, and many other applications. In 2004, Freedman et at. [1] introduced a probabilistic solution for this problem, and they extended it to malicious adversary model and multi-party computation. In this paper, we propose a new deterministic protocol for private matching with perfect correctness. We apply this technique to adversary models, achieving more reliable and higher speed computation.

Usefulness of Data Mining in Criminal Investigation (데이터 마이닝의 범죄수사 적용 가능성)

  • Kim, Joon-Woo;Sohn, Joong-Kweon;Lee, Sang-Han
    • Journal of forensic and investigative science
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    • v.1 no.2
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    • pp.5-19
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    • 2006
  • Data mining is an information extraction activity to discover hidden facts contained in databases. Using a combination of machine learning, statistical analysis, modeling techniques and database technology, data mining finds patterns and subtle relationships in data and infers rules that allow the prediction of future results. Typical applications include market segmentation, customer profiling, fraud detection, evaluation of retail promotions, and credit risk analysis. Law enforcement agencies deal with mass data to investigate the crime and its amount is increasing due to the development of processing the data by using computer. Now new challenge to discover knowledge in that data is confronted to us. It can be applied in criminal investigation to find offenders by analysis of complex and relational data structures and free texts using their criminal records or statement texts. This study was aimed to evaluate possibile application of data mining and its limitation in practical criminal investigation. Clustering of the criminal cases will be possible in habitual crimes such as fraud and burglary when using data mining to identify the crime pattern. Neural network modelling, one of tools in data mining, can be applied to differentiating suspect's photograph or handwriting with that of convict or criminal profiling. A case study of in practical insurance fraud showed that data mining was useful in organized crimes such as gang, terrorism and money laundering. But the products of data mining in criminal investigation should be cautious for evaluating because data mining just offer a clue instead of conclusion. The legal regulation is needed to control the abuse of law enforcement agencies and to protect personal privacy or human rights.

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