The insurance fraud is frequent type of criminality at the present time. The perpetrators of this crime cause heavy economic damages to insurance companies. Objective of the thesis called "The insurance fraud in the Czech Republic" is to evaluate the current state of the problem of insurance fraud in the Czech Republic from the perspective of insurance companies, law enforcement authorities and new legislation. As well to describe the way of detection and investigation, characterize the offender, analyze the most frequent cases, typical methods of committing insurance fraud and to evaluate the statistics and trends from previous years. In the thesis are explained the principles of detecting insurance fraud in insurance companies and the preventive measures. Part of the thesis is to identify weaknesses in the fight against the insurance fraud.

Historically, progress in technology development has continually created new opportunities for criminal activities which, in turn, have triggered the need for the development of new security-sensitive systems. Organisations are now adopting mobile technologies for numerous applications to capitalise on the mobile revolution. They are now able to increase their operational efficiency as well as responsiveness and competitiveness and, most importantly, can now meet new, growing customers’ demands. However, although mobile technologies and applications present many new opportunities, they also present challenges. Threats to mobile phone applications are always on the rise and, therefore, compel organisations to invest money and time, among other technical controls, in an attempt to protect them from incurring losses. The computerisation of core activities (such as mobile banking in the banking industry, for example) has effectively exposed organisations to a host of complex fraud challenges that they have to deal with in addition to their core business of providing services to their end consumers. Fraudsters are able to use mobile devices to remotely access enterprise applications and subsequently perform fraudulent transactions. When this occurs, it is important to effectively investigate and manage the cause and findings, as well as to prevent any future similar attacks. Unfortunately, clients and consumers of these organisations are often ignorant of the risks to their assets and the consequences of the compromises that might occur. Organisations are therefore obliged, at least, to put in place measures that will not only minimise fraud but also be capable of detecting and preventing further similar incidents. The goal of this research was to develop a unified fraud management and digital forensic framework to improve the security of Information Technology (IT) processes and operations in organisations that make available mobile phone applications to their clients for business purposes. The research was motivated not only by the increasing reliance of organisations on mobile applications to service their customers but also by the fact that digital forensics and fraud management are often considered to be separate entities at an organisational level. This study proposes a unified approach to fraud management and digital forensic analysis to simultaneously manage and investigate fraud that occurs through the use of mobile phone applications. The unified Fraud Management and Digital Forensic (FMDF) framework is designed to (a) determine the suspicious degree of fraudulent transactions and (b) at the same time, to feed into a process that facilitates the investigation of incidents. A survey was conducted with subject matter experts in the banking environment. Data was generated through a participatory self-administered online questionnaire. Collected data was then presented, analysed and interpreted quantitatively and qualitatively. The study found that there was a general understanding of the common fraud management methodologies and approaches throughout the banking industry and the use thereof. However, while many of the respondents indicated that fraud detection was an integral part of their processes, they take a rather reactive approach when it comes to fraud management and digital forensics. Part of the reason for the reactive approach is that many investigations are conducted in silos, with no central knowledge repository where previous cases can be retrieved for comparative purposes. Therefore, confidentiality, integrity and availability of data are critical for continued business operations. To mitigate the pending risks, the study proposed a new way of thinking that combines both components of fraud management and digital forensics for an optimised approach to managing security in mobile applications. The research concluded that the unified FMDF approach was considered to be helpful and valuable to professionals who participated in the survey. Although the case study focused on the banking industry, the study appears to be instrumental in informing other types of organisations that make available the use of mobile applications for their clients in fraud risk awareness and risk management in general. / Computing / M. Sc. (Computing)

Segundo relatório da auditoria KPMG, 69% das empresas admitiram ser vítimas de algum tipo de fraude. Em 2010, no setor bancário foram perdidos aproximadamente R$ 1,5 bilhões devido às fraudes financeiras cometidas em clientes considerando apenas as fraudes documentais e as perdas com fraudes bancárias eletrônicas superaram os 900 milhões neste mesmo ano. Os tipos de fraudes cometidas foram diversos, dentre eles a fraude durante a abertura de contas, cheques clonados, falsificação de documentos, alterações de códigos de barras e clonagem de cartões. A fraude é um problema frequente nas organizações e bastante discutido no mercado, porém verificou-se a existência de uma lacuna teórica quando se trata de gestão da fraude externa. O objetivo do trabalho foi a estruturação de um quadro conceitual para a Gestão da Fraude Financeira e a sua comparação com a prática.Este é um estudo qualitativo exploratório e foi realizado por meio da análise baseada na Teoria Fundamentada definindo categorias a partir da literatura disponível e a sua comparação com entrevistas feitas em um banco de varejo brasileiro e uma associação de instituições financeiras, além dos artigos jornalísticos. Com relação à utilização dos resultados esta é uma pesquisa aplicada já que seu resultado pode, além de contribuir para a discussão teórica, ser aplicada em qualquer organização interessada em gerir a fraude financeira. Os resultados da elaboração do quadro conceitual mostram que a gestão da fraude financeira externa tem quatro fases: a Contínua, a Prevenção, Detecção e a Reação e as categorias definidas estão inseridas nelas. Quanto à comparação da teoria com a prática, nem todos os aspectos verificados na literatura puderam ser encontrados nos relatos das entrevistas e nos artigos jornalísticos analisados. / According to KPMG audit report, 69% of companies admitted being victims of some kind of fraud. In 2010, the banking sector have lost approximately R$ 1.5 billion due to financial fraud perpetrated on customers considering only documentary fraud and the electronic banking fraud losses exceeded R$ 900 million in the same year. The types of fraud were many, including fraud during account opening, cloned checks, forgery, alteration barcode and card cloning. Fraud is a common problem in organizations and widely discussed in the market, however it was found that there is a theoretical gap when it comes to managing external fraud. The objective of this research was to structure a conceptual framework for the Management of Fraud and its comparison with the practice. This is an exploratory qualitative study and was conducted through analysis based on Grounded Theory defining categories from the available literature and interviews with comparison to a bank and an association of financial institutions, in addition to news articles. Regarding the use of results is an applied research its result can also contribute to the theoretical discussion, and be applied to any organization interested in managing financial fraud. The results of the development of the conceptual framework shows that the management of external financial fraud has four phases: Continuous, Prevention, Detection and Reaction and the defined categories are located in them. Regarding the comparison of theory with practice, not all aspects verified in the literature could be found in the reports of interviews and newspaper articles analyzed.

The thesis focus on fraud management - the detection of fraudulent behavior. In the first part current market situation in finance, telecommunications and healthcare is mapped. Following section contains the review of methods used for data mining which is closely related to detection of fradulent or non-standard behaviour. Part of the thesis is focused on the fraudulent behaviour detection in the procurement area. The whole cycle of deployment and use of the tool for detection is introduced. It covers data collection, identification of suspected cases, outcomes analysis and recommendations how to prevent from fraud.

abstract: Fraud is defined as the utilization of deception for illegal gain by hiding the true nature of the activity. While organizations lose around $3.7 trillion in revenue due to financial crimes and fraud worldwide, they can affect all levels of society significantly. In this dissertation, I focus on credit card fraud in online transactions. Every online transaction comes with a fraud risk and it is the merchant's liability to detect and stop fraudulent transactions. Merchants utilize various mechanisms to prevent and manage fraud such as automated fraud detection systems and manual transaction reviews by expert fraud analysts. Many proposed solutions mostly focus on fraud detection accuracy and ignore financial considerations. Also, the highly effective manual review process is overlooked. First, I propose Profit Optimizing Neural Risk Manager (PONRM), a selective classifier that (a) constitutes optimal collaboration between machine learning models and human expertise under industrial constraints, (b) is cost and profit sensitive. I suggest directions on how to characterize fraudulent behavior and assess the risk of a transaction. I show that my framework outperforms cost-sensitive and cost-insensitive baselines on three real-world merchant datasets. While PONRM is able to work with many supervised learners and obtain convincing results, utilizing probability outputs directly from the trained model itself can pose problems, especially in deep learning as softmax output is not a true uncertainty measure. This phenomenon, and the wide and rapid adoption of deep learning by practitioners brought unintended consequences in many situations such as in the infamous case of Google Photos' racist image recognition algorithm; thus, necessitated the utilization of the quantified uncertainty for each prediction. There have been recent efforts towards quantifying uncertainty in conventional deep learning methods (e.g., dropout as Bayesian approximation); however, their optimal use in decision making is often overlooked and understudied. Thus, I present a mixed-integer programming framework for selective classification called MIPSC, that investigates and combines model uncertainty and predictive mean to identify optimal classification and rejection regions. I also extend this framework to cost-sensitive settings (MIPCSC) and focus on the critical real-world problem, online fraud management and show that my approach outperforms industry standard methods significantly for online fraud management in real-world settings. / Dissertation/Thesis / Doctoral Dissertation Computer Science 2019

The financial costs of U.S. federal health care fraud continue to increase, and as health care payments due to fraudulent claims increase, the portion of The Medicare Trust Fund available to pay for legitimate health care expenses decreases. Prosecution is one of several fraud management life cycle components that contributes to and can alter the course of increasing health care fraud; however, despite this recognition, there is a gap in the literature regarding the consistency of prosecution for federal health care fraud across different judicial districts. The purpose of this qualitative, exploratory multiple case study was to explore the federal sentencing consistency across 6 judicial districts in Georgia and Florida during 2011 and 2012 using Wilhelm's Fraud Management Life Cycle as the theoretical lens. Data consisted of publicly available records of 147 terminated federal cases in Georgia or Florida from 2011 and 2012 involving prosecutions for health care-related fraud. These data were inductively coded and analyzed using a content analysis procedure. Findings indicated physical and monetary sentencing inconsistencies when comparing the sentence delivered for similar federal health care fraud cases across judicial jurisdictions. This study promotes positive social change by demonstrating inconsistencies in federal health care sentencing and understanding that consistent sentencing will lead to greater deterrence. Prosecutors and judges will benefit from this knowledge in making more consistent sentencing decisions related to federal fraudulent health care payments.

Segundo relatório da auditoria KPMG, 69% das empresas admitiram ser vítimas de algum tipo de fraude. Em 2010, no setor bancário foram perdidos aproximadamente R$ 1,5 bilhões devido às fraudes financeiras cometidas em clientes considerando apenas as fraudes documentais e as perdas com fraudes bancárias eletrônicas superaram os 900 milhões neste mesmo ano. Os tipos de fraudes cometidas foram diversos, dentre eles a fraude durante a abertura de contas, cheques clonados, falsificação de documentos, alterações de códigos de barras e clonagem de cartões. A fraude é um problema frequente nas organizações e bastante discutido no mercado, porém verificou-se a existência de uma lacuna teórica quando se trata de gestão da fraude externa. O objetivo do trabalho foi a estruturação de um quadro conceitual para a Gestão da Fraude Financeira e a sua comparação com a prática.Este é um estudo qualitativo exploratório e foi realizado por meio da análise baseada na Teoria Fundamentada definindo categorias a partir da literatura disponível e a sua comparação com entrevistas feitas em um banco de varejo brasileiro e uma associação de instituições financeiras, além dos artigos jornalísticos. Com relação à utilização dos resultados esta é uma pesquisa aplicada já que seu resultado pode, além de contribuir para a discussão teórica, ser aplicada em qualquer organização interessada em gerir a fraude financeira. Os resultados da elaboração do quadro conceitual mostram que a gestão da fraude financeira externa tem quatro fases: a Contínua, a Prevenção, Detecção e a Reação e as categorias definidas estão inseridas nelas. Quanto à comparação da teoria com a prática, nem todos os aspectos verificados na literatura puderam ser encontrados nos relatos das entrevistas e nos artigos jornalísticos analisados. / According to KPMG audit report, 69% of companies admitted being victims of some kind of fraud. In 2010, the banking sector have lost approximately R$ 1.5 billion due to financial fraud perpetrated on customers considering only documentary fraud and the electronic banking fraud losses exceeded R$ 900 million in the same year. The types of fraud were many, including fraud during account opening, cloned checks, forgery, alteration barcode and card cloning. Fraud is a common problem in organizations and widely discussed in the market, however it was found that there is a theoretical gap when it comes to managing external fraud. The objective of this research was to structure a conceptual framework for the Management of Fraud and its comparison with the practice. This is an exploratory qualitative study and was conducted through analysis based on Grounded Theory defining categories from the available literature and interviews with comparison to a bank and an association of financial institutions, in addition to news articles. Regarding the use of results is an applied research its result can also contribute to the theoretical discussion, and be applied to any organization interested in managing financial fraud. The results of the development of the conceptual framework shows that the management of external financial fraud has four phases: Continuous, Prevention, Detection and Reaction and the defined categories are located in them. Regarding the comparison of theory with practice, not all aspects verified in the literature could be found in the reports of interviews and newspaper articles analyzed.

The subject of this Master thesis is an application of fraud detection softwares. Except computer assisted audit tools and techniques and fraud management systems thesis deal with new methods like using neural network model or logistic regresion model.The thesis also contains comparison of the best softwares for fraud examinations.

Financial reporting fraud is a concern for investors, regulators, external auditors, and the public. Although the responsibility for fraud detection lies upon management and those charged with governance, external auditors are likely to come under scrutiny if fraud scandals come to light. Despite the audit regulators efforts in fighting fraud, evidence from prior literature revealed that external auditors still need guidance in assessing and responding to fraud risks. Hence the current study aims at helping external auditors properly assess and respond to the risk of financial reporting fraud in an effort to increase the likelihood of detecting it. In order to achieve this, the current study sought to explore the significance of various fraud factors in assessing the risks of financial reporting fraud and examined how external auditors could assess these fraud factors. The current study also explored the likely motivations behind management fraud, the impact of management motivations on the financial statements, and how external auditors could assess the impact of management motivations. The data for the current study was collected from external auditors working at various audit firms in Egypt via the use of mixed research methods, namely through an online questionnaire and semi-structured interviews. The findings of the current study revealed that management motives are the most significant factor in assessing the risk of financial reporting fraud. Hence the current study suggests that external audit should be viewed in terms of management motivations rather than just the audit of financial statements figures and disclosures. The current study offers detailed guidance to external auditors in this area. The findings of the current study also revealed that management integrity is a significant factor in assessing the risk of financial reporting fraud and that rationalisation of fraud should be assessed as part of management integrity rather than a separate fraud risk factor. The current study found that fraud perpetrators capabilities are equally significant to the opportunity to commit fraud factor yet it is currently ignored by the audit standards and thus should be assessed as part of opportunity to commit fraud. The current study was the first to explore financial reporting fraud and the extent by which external auditors comply with ISA 240 in the Egyptian context. The current study offered recommendations to external auditors, audit firms, audit regulators, and the Egyptian government on how to combat financial reporting fraud. Potential areas for future research were also identified by the current study.

保險詐欺是自有保險制度以來就有的問題，世界各國都被這個問題所困擾。因為沒有受到廣泛的宣傳及討論，加上執法機關的忽視、抗拒提供調查機能及加強追訴，所以在1980年代以前沒有被當作重大問題予以重視，一般民眾完全不知它的嚴重性，把它當作「沒有被害人的犯罪（victimless crime）」。然而保險詐欺隨時都在發生，而且範圍及程度日益擴大，已堪稱為「溫和的巨災（quiet catastrophe）」，不但影響個人經濟負擔，且破壞社會安定，因此本文就如何防制保險詐欺加以探討。 保險詐欺直接衝擊的是保險公司的經營穩定性與安全性，對保險公司而言是經營上的風險，因此從風險管理的角度，分析保險公司的實務運作，探討運用各種風險管理對策防制保險詐欺的可行性。經本文研究發覺以風險管理模式可以防制保險詐欺或減輕保險詐欺的損失，各種風險管理對策運用如下： （一） 風險自承原則：對規模小、影響層面小的保險詐欺案件，列為「堪忍的詐欺」，予以承受，以節省相關的查證經費。 （二） 風險規避原則：建立「防範保險詐欺查核表」，在進行核保、理賠作業時嚴格查核，積極避開保險詐欺風險。 （三） 風險分散原則：針對損失頻率低、損失幅度大的案件採取同業共保的方式；對損失頻率高、損失幅度小的案件採取約定自負額方式承保，以分散風險。 （四） 風險轉嫁原則：約集保險同業成立相互保險組織，把保險詐欺所帶來的風險移轉給相互保險組織。 保險詐欺基本上是犯罪行為，要消弭犯罪行為可以藉由對犯罪環境加以有效管理、設計或操作，以及降低犯罪機會達到目的。本文研究發現推動「詐欺管理生命週期理論」的嚇阻、預防、察覺、緩和、分析、政策、偵查、追溯等措施，及「情境犯罪預防理論」的增加犯罪困難度、提升犯罪風險、降低犯罪報酬、削弱犯罪動機等措施，喚起全民共同防制保險詐欺的意念，可以壓制保險詐欺之發生。 嚴謹的法令規範是防制犯罪的根本，經由本文的探討發覺保險詐欺的盛行，除了民眾法治觀念差以外，現行法令不周全，讓歹徒有機可乘及執法單位強制力不足，亦是原因之一。修訂保險法及刑法，對於防制保險詐欺有很大的效益。 / “Insurance Fraud” has been an issue, by which the countries all over the world are perplexed, since there exists the system of insurance. By 1980’s, not much attention has been paid to this issue which deemed a victimless crime and the public does not realize how serious the problem is due to the lake of broad propaganda and the ignorance, being rejected to offer the function, and being refused to strengthen prosecution by the law enforcement agency. Nevertheless, insurance fraud happens all the time and has already been called the “quiet catastrophe” because the range and severity caused keep expanding day by day. Resulting from, not only the financial burden of the individual is influenced, but the social stability is destroyed as well. Therefore, this paper probed into “how to prevent Insurance Fraud”. Since Insurance Fraud would strike the financial stability and security of an insurance company, it becomes kind of risk on company’s management. This paper would be analyzing the practical operation of an insurance company and trying to find out the feasibility of Insurance Fraud Prevention by using various kinds of risk management countermeasures. By which, this paper discovers the losses caused by insurance fraud could be prevented and/ or reduced. The followings are those risk management countermeasures studied and applied: A. The principle of “Risk Retention & Reduction”: Sorting out those cases by loss amount scale. Smaller ones are classified & named as “Admitted Fraud”, and settled without verification in order to save the related expenses for investigation. B. The principle of “Risk Avoidance or Hedging”: Setting up “Checking List of Insurance Fraud”, by using which to actively avoid the risk of insurance fraud while carrying on the operations of underwriting and claim handling. C. The principle of “Risk Sharing & Diversification”: Co-insuring with peer companies for those accounts with the characteristic of low frequency & high severity in terms of loss exposure. As to other accounts, appointing an appropriate policy deductible level to disperse the risk of Insurance Fraud. D. The principle of “Risk Transference or Shift”: Establishing the pooling system or organization to transfer the risk of Insurance Fraud to the peer companies. Basically, Insurance Fraud is a criminal offence, which could be eliminated and / or reduced by way of methods of management, design, and operation on the crime environment. It is found that the occurrence of Insurance Fraud could be depressed by: A. Promoting measures of “The Fraud Management Lifecycle Theory”, such as deterrence, prevention, detection, mitigation, analysis, policy, investigation, prosecution etc., and B. Executing the countermeasures of “The Situational Crime Prevention Theory” such as increasing perceived efforts, increasing perceived risks, reducing anticipated reward, removing excuses etc., and C. Arousing the public the thought of fighting Insurance Fraud mutually. A rigorous legal system is the base of preventing criminal offence. As discovered and presented by this paper, reasons why the Insurance Fraud has been prevailing are not only because of a poor sense of legal compliance of the public, but also the un-thoroughness of the current legal system resulting in offering ruffians opportunities to take advantages from Insurance Fraud and the in-sufficient power of prosecution of the law enforcement agency. Therefore, to revise the insurance law and criminal law would be greatly workable for preventing Insurance Fruad.