An expert system for detecting automobile insurance fraud using social network analysis

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 algorithm, Iterative Assessment Algorithm (IAA), also presented in the article. Besides intrinsic attributes of entities, the algorithm explores also the relations between entities. The prototype was evaluated and rigorously analyzed on real world data. Results show that automobile insurance fraud can be efficiently detected with the proposed system and that appropriate data representation is vital. Key words: Fraud detection, Automobile insurance, Social network analysis, Link analysis, Assessment propagation 1. Introduction Fraud is encountered in a variety of domains. It comes in all different shapes and sizes, from traditional fraud, e.g. Such groups can be found in the automobile insurance domain. Here fraudsters stage traffic accidents and issue fake insurance claims to gain (unjustified) funds from their general or vehicle insurance. There are also cases where an accident has never occurred, and the vehicles have only been placed onto the road. Still, the majority of such fraud is not planned (opportunistic fraud) - an individual only seizes the opportunity arising from the accident and issues exaggerated insurance claims or claims for past damages. Staged accidents have several common characteristics. They occur in late hours and non-urban areas in order to reduce the probability of witnesses. Drivers are usually younger males, there are many passengers in the vehicles, but never children or elders. The police is always called to the scene to make the subsequent acquisition of means easier. It is also not uncommon that all of the participants have multiple (serious) injuries, when there is almost no damage on the vehicles. Many other suspicious characteristics exist, not mentioned here.