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Medical insurance claims are of organized crimes related to patients, physicians, diagnostic centers, and insurance providers, forming a chain reaction that must be monitored constantly. These kinds of frauds affect the financial growth of…
With an increase in financial accounting fraud in the current economic scenario experienced, financial accounting fraud detection has become an emerging topics of great importance for academics, research and industries. Financial fraud is a…
Credit card is one of the most extensive methods of instalment for both online and offline mode of payment for electronic transactions in recent times. credit cards invention has provided significant ease in electronic transactions.…
Insurance companies must manage millions of claims per year. While most of these claims are non-fraudulent, fraud detection is core for insurance companies. The ultimate goal is a predictive model to single out the fraudulent claims and pay…
The insurance industry has been creating innovative products around the emerging online shopping activities. Such e-commerce insurance is designed to protect buyers from potential risks such as impulse purchases and counterfeits. Fraudulent…
In this report, I present a deep learning approach to conduct a natural language processing (hereafter NLP) binary classification task for analyzing financial-fraud texts. First, I searched for regulatory announcements and enforcement…
Traditionally, the detection of fraudulent insurance claims relies on business rules and expert judgement which makes it a time-consuming and expensive process (\'Oskarsd\'ottir et al., 2022). Consequently, researchers have been examining…
Risk adjustment has become an increasingly important tool in healthcare. It has been extensively applied to payment adjustment for health plans to reflect the expected cost of providing coverage for members. Risk adjustment models are…
Medicare fraud results in considerable losses for governments and insurance companies and results in higher premiums from clients. Medicare fraud costs around 13 billion euros in Europe and between 21 billion and 71 billion US dollars per…
Credit card frauds are at an ever-increasing rate and have become a major problem in the financial sector. Because of these frauds, card users are hesitant in making purchases and both the merchants and financial institutions bear heavy…
Payment card fraud causes multibillion dollar losses for banks and merchants worldwide, often fueling complex criminal activities. To address this, many real-time fraud detection systems use tree-based models, demanding complex feature…
With an upsurge in financial accounting fraud in the current economic scenario experienced, financial accounting fraud detection (FAFD) has become an emerging topic of great importance for academic, research and industries. The failure of…
Fraud in healthcare is widespread, as doctors could prescribe unnecessary treatments to increase bills. Insurance companies want to detect these anomalous fraudulent bills and reduce their losses. Traditional fraud detection methods use…
Accounting fraud is a global concern representing a significant threat to the financial system stability due to the resulting diminishing of the market confidence and trust of regulatory authorities. Several tricks can be used to commit…
Improper health insurance payments resulting from fraud and upcoding result in tens of billions of dollars in excess health care costs annually in the United States, motivating machine learning researchers to build anomaly detection models…
Fraud detection is to identify, monitor, and prevent potentially fraudulent activities from complex data. The recent development and success in AI, especially machine learning, provides a new data-driven way to deal with fraud. From a…
Learning to detect fraud in large-scale accounting data is one of the long-standing challenges in financial statement audits or fraud investigations. Nowadays, the majority of applied techniques refer to handcrafted rules derived from known…
Healthcare insurance provides financial support to access medical services for patients while ensuring timely and guaranteed payment for providers. Insurance fraud poses a significant challenge to insurance companies and policyholders,…
Machine learning plays an essential role in preventing financial losses in the banking industry. Perhaps the most pertinent prediction task that can result in billions of dollars in losses each year is the assessment of credit risk (i.e.,…
Insurance fraud occurs when policyholders file claims that are exaggerated or based on intentional damages. This contribution develops a fraud detection strategy by extracting insightful information from the social network of a claim.…