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. First, we construct a network by linking claims with all their involved parties, including the policyholders, brokers, experts, and garages. Next, we establish fraud as a social phenomenon in the network and use the BiRank algorithm with a fraud specific query vector to compute a fraud score for each claim. From the network, we extract features related to the fraud scores as well as the claims' neighborhood structure. Finally, we combine these network features with the claim-specific features and build a supervised model with fraud in motor insurance as the target variable. Although we build a model for only motor insurance, the network includes claims from all available lines of business. Our results show that models with features derived from the network perform well when detecting fraud and even outperform the models using only the classical claim-specific features. Combining network and claim-specific features further improves the performance of supervised learning models to detect fraud. The resulting model flags highly suspicions claims that need to be further investigated. Our approach provides a guided and intelligent selection of claims and contributes to a more effective fraud investigation process.
The Automobile Insurance Fraud is one of the main challenges for insurance companies. This form of fraud is performed either opportunistic or professional occurring through group cooperation that leads to greater financial losses, while most presented methods thus far are unsuited for flagging these groups. The article has put forward a new approach for identification, representation, and analysis of organized fraudulent groups in automobile insurance through focusing on structural aspects of networks, and cycles in particular, that demonstrate the occurrence of potential fraud. Suspicious gro…
Faculty of Computer and Information Science, University of Ljubljana（卢布尔雅那大学计算机与信息科学学院）
The article proposes an expert system for detection, and subsequent investigation, of groups of collaborating automobile insurance fraudsters. The system is described and examined in great detail, several technical difficulties in detecting fraud are also considered, for it to be applicable in practice. Opposed to many other approaches, the system uses networks for representation of data. Networks are the most natural representation of such a relational domain, allowing formulation and analysis of complex relations between entities. Fraudulent entities are found by employing a novel assessment…
Blockchain technology has piqued the interest of businesses of all types, while consistently improving and adapting to developers and business owners requirements. Therefore, several blockchain platforms have emerged, making it challenging to select a suitable one for a specific type of business. This paper presents a classification of over one hundred blockchain platforms. We develop smart contracts for detecting healthcare insurance frauds using two blockchain platforms selected based on our proposed decision-making map approach for the selection of the top two suitable platforms for healthc…
Inductive inference of gradient-boosted decision trees on graphs for insurance fraud detection
Data Office, Allianz Benelux（Allianz Benelux 数据办公室）；KU Leuven University of Antwerp-imec（安特卫普-imec 联合大学KU Leuven）；KU Leuven；University of Antwerp-imec（安特卫普-imec 大学）
As businesses increasingly rely on social networking sites to engage with their customers, it is crucial to understand and counter reputation manipulation activities, including fraudulently boosting the number of Facebook page likes using like farms. To this end, several fraud detection algorithms have been proposed and some deployed by Facebook that use graph co-clustering to distinguish between genuine likes and those generated by farm-controlled profiles. However, as we show in this paper, these tools do not work well with stealthy farms whose users spread likes over longer timespans and li…
Health insurance companies in Brazil have their data about claims organized having the view only for providers. In this way, they loose the physician view and how they share patients. Partnership between physicians can view as a fruitful work in most of the cases but sometimes this could be a problem for health insurance companies and patients, for example a recommendation to visit another physician only because they work in same clinic. The focus of the work is to better understand physicians activities and how these activities are represented in the data. Our approach considers three aspects…
Financial frauds cause billions of losses annually and yet it lacks efficient approaches in detecting frauds considering user profile and their behaviors simultaneously in social network . A social network forms a graph structure whilst Graph neural networks (GNN), a promising research domain in Deep Learning, can seamlessly process non-Euclidean graph data . In financial fraud detection, the modus operandi of criminals can be identified by analyzing user profile and their behaviors such as transaction, loaning etc. as well as their social connectivity. Currently, most GNNs are incapable of se…
National Digital Switching System Engineering and Technological Research Center（国家数字交换系统工程技术研究中心）；University of Toronto（多伦多大学）；Fudan University（复旦大学）
With the rapid development of mobile networks, the people's social contacts have been considerably facilitated. However, the rise of mobile social network fraud upon those networks, has caused a great deal of distress, in case of depleting personal and social wealth, then potentially doing significant economic harm. To detect fraudulent users, call detail record (CDR) data, which portrays the social behavior of users in mobile networks, has been widely utilized. But the imbalance problem in the aforementioned data, which could severely hinder the effectiveness of fraud detectors based on graph…
Ant Financial Services Group（蚂蚁金融服务集团）；Tsinghua University（清华大学）
With the rapid growth of financial services, fraud detection has been a very important problem to guarantee a healthy environment for both users and providers. Conventional solutions for fraud detection mainly use some rule-based methods or distract some features manually to perform prediction. However, in financial services, users have rich interactions and they themselves always show multifaceted information. These data form a large multiview network, which is not fully exploited by conventional methods. Additionally, among the network, only very few of the users are labelled, which also pos…
Efficient financial administrations need to ensure compliant behavior of all tax subjects without excessive personnel costs or obstruction of compliant companies. To do so, accurate prediction of non-compliance or fraud is crucial. Social Network Analysis (SNA) provides powerful tools for fraud prediction as fraudulence is often clustered in certain areas of real world social networks. In this paper we present our results of comparing PageRank and the more recent BiRank to infer risk-ranks based on network structure and prior fraud information. Specifically, we model our social network from co…
Most past work on social network link fraud detection tries to separate genuine users from fraudsters, implicitly assuming that there is only one type of fraudulent behavior. But is this assumption true? And, in either case, what are the characteristics of such fraudulent behaviors? In this work, we set up honeypots ("dummy" social network accounts), and buy fake followers (after careful IRB approval). We report the signs of such behaviors including oddities in local network connectivity, account attributes, and similarities and differences across fraud providers. Most valuably, we discover an…
Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most countries is the access gate to health care, is just an intermediate factor of well-being. We used soci…
Cyber attacks such as phishing, IRS scams, etc., still are successful in fooling Internet users. Users are the last line of defense against these attacks since attackers seem to always find a way to bypass security systems. Understanding users' reason about the scams and frauds can help security providers to improve users security hygiene practices. In this work, we study the users' reasoning and the effectiveness of several variables within the context of the company representative fraud. Some of the variables that we study are: 1) the effect of using LinkedIn as a medium for delivering the p…
Graph embedding technics are studied with interest on public datasets, such as BlogCatalog, with the common practice of maximizing scoring on graph reconstruction, link prediction metrics etc. However, in the financial sector the important metrics are often more business related, for example fraud detection rates. With our privileged position of having large amount of real-world non-public P2P-lending social data, we aim to study empirically whether recent advances in graph embedding technics provide a useful signal for metrics more closely related to business interests, such as fraud detectio…
Fraud has severely detrimental impacts on the business of social networks and other online applications. A user can become a fake celebrity by purchasing "zombie followers" on Twitter. A merchant can boost his reputation through fake reviews on Amazon. This phenomenon also conspicuously exists on Facebook, Yelp and TripAdvisor, etc. In all the cases, fraudsters try to manipulate the platform's ranking mechanism by faking interactions between the fake accounts they control and the target customers.
Given a set $Ω$ and a proximity function $ϕ: Ω\times Ω\to \mathbb R^+$, we define a new metric for $Ω$ by considering a path distance in $Ω$, that is considered as a complete graph. We analyze the properties of such a distance, and several procedures for defining the initial proximity matrix $( ϕ(a,b) )_{(a,b) \in Ω\times Ω}.$ Our motivation has its roots in the current interest in finding effective algorithms for detecting and classifying relations among elements of a social network. For example, the analysis of a set of companies working for a given public administration or other figures in …
Social reviews are indispensable resources for modern consumers' decision making. For financial gain, companies pay fraudsters preferably in groups to demote or promote products and services since consumers are more likely to be misled by a large number of similar reviews from groups. Recent approaches on fraudster group detection employed handcrafted features of group behaviors without considering the semantic relation between reviews from the reviewers in a group. In this paper, we propose the first neural approach, HIN-RNN, a Heterogeneous Information Network (HIN) Compatible RNN for frauds…
National Cheng Kung University（国立成功大学）；National Tsing Hua University（国立清华大学）；Leopard Mobile Inc.（豹移动公司）
The cryptocurrency is attracting more and more attention because of the blockchain technology. Ethereum is gaining a significant popularity in blockchain community, mainly due to the fact that it is designed in a way that enables developers to write smart contracts and decentralized applications (Dapps). There are many kinds of cryptocurrency information on the social network. The risks and fraud problems behind it have pushed many countries including the United States, South Korea, and China to make warnings and set up corresponding regulations. However, the security of Ethereum smart contrac…
We are living in an era when online communication over social network services (SNSs) have become an indispensable part of people's everyday lives. As a consequence, online social deception (OSD) in SNSs has emerged as a serious threat in cyberspace, particularly for users vulnerable to such cyberattacks. Cyber attackers have exploited the sophisticated features of SNSs to carry out harmful OSD activities, such as financial fraud, privacy threat, or sexual/labor exploitation. Therefore, it is critical to understand OSD and develop effective countermeasures against OSD for building a trustworth…
Benford's Law states that the frequency of first digits of numbers in naturally occurring systems is not evenly distributed. Numbers beginning with a 1 occur roughly 30\% of the time, and are six times more common than numbers beginning with a 9. We show that Benford's Law applies to social and behavioral features of users in online social networks. We consider social data from five major social networks: Facebook, Twitter, Google Plus, Pinterest, and Live Journal. We show that the distribution of first significant digits of friend and follower counts for users in these systems follow Benford'…
Anomalies in online social networks can signify irregular, and often illegal behaviour. Anomalies in online social networks can signify irregular, and often illegal behaviour. Detection of such anomalies has been used to identify malicious individuals, including spammers, sexual predators, and online fraudsters. In this paper we survey existing computational techniques for detecting anomalies in online social networks. We characterise anomalies as being either static or dynamic, and as being labelled or unlabelled, and survey methods for detecting these different types of anomalies. We suggest…
Social media anomaly detection is of critical importance to prevent malicious activities such as bullying, terrorist attack planning, and fraud information dissemination. With the recent popularity of social media, new types of anomalous behaviors arise, causing concerns from various parties. While a large amount of work have been dedicated to traditional anomaly detection problems, we observe a surge of research interests in the new realm of social media anomaly detection. In this paper, we present a survey on existing approaches to address this problem. We focus on the new type of anomalous …
Online Social Networks (OSNs) play an important role for internet users to carry out their daily activities like content sharing, news reading, posting messages, product reviews and discussing events etc. At the same time, various kinds of spammers are also equally attracted towards these OSNs. These cyber criminals including sexual predators, online fraudsters, advertising campaigners, catfishes, and social bots etc. exploit the network of trust by various means especially by creating fake profiles to spread their content and carry out scams. All these malicious identities are very harmful fo…
How can we detect suspicious users in large online networks? Online popularity of a user or product (via follows, page-likes, etc.) can be monetized on the premise of higher ad click-through rates or increased sales. Web services and social networks which incentivize popularity thus suffer from a major problem of fake connections from link fraudsters looking to make a quick buck. Typical methods of catching this suspicious behavior use spectral techniques to spot large groups of often blatantly fraudulent (but sometimes honest) users. However, small-scale, stealthy attacks may go unnoticed due…
Recent technological advancements have resulted in a surge in online trading, raising severe concerns about theft and fraud, especially on platforms like Bitcoin OTC (over-the-counter), where users' identities remain anonymous. To mitigate the risk, it has become essential to capture the reputation of users based on their trade histories. The who-trusts-whom signed network of people has the capability to reflect the nature of such positive and negative relations between the users. It can be used to analyze linkage patterns, strength, and resiliency of such platforms. Due to the dynamic nature …
