Graph-based methods are becoming increasingly popular in machine learning due to their ability to model complex data and relations. Insurance fraud is a prime use case, since false claims are often the result of organised criminals that stage accidents or the same persons filing erroneous claims on multiple policies. One challenge is that graph-based approaches struggle to find meaningful representations of the data because of the high class imbalance present in fraud data. Another is that insurance networks are heterogeneous and dynamic, given the changing relations among people, companies and policies. That is why gradient boosted tree approaches on tabular data still dominate the field. Therefore, we present a novel inductive graph gradient boosting machine (G-GBM) for supervised learning on heterogeneous and dynamic graphs. We show that our estimator competes with popular graph neural network approaches in an experiment using a variety of simulated random graphs. We demonstrate the power of G-GBM for insurance fraud detection using an open-source and a real-world, proprietary dataset. Given that the backbone model is a gradient boosting forest, we apply established explainability methods to gain better insights into the predictions made by G-GBM.

Insurance fraud detection represents a pivotal advancement in modern insurance service, providing intelligent and digitalized monitoring to enhance management and prevent fraud. It is crucial for ensuring the security and efficiency of insurance systems. Although AI and machine learning algorithms have demonstrated strong performance in detecting fraudulent claims, the absence of standardized defense mechanisms renders current systems vulnerable to emerging adversarial threats. In this paper, we propose a GAN-based approach to conduct adversarial attacks on fraud detection systems. Our results indicate that an attacker, without knowledge of the training data or internal model details, can generate fraudulent cases that are classified as legitimate with a 99\% attack success rate (ASR). By subtly modifying real insurance records and claims, adversaries can significantly increase the fraud risk, potentially bypassing compromised detection systems. These findings underscore the urgent need to enhance the robustness of insurance fraud detection models against adversarial manipulation, thereby ensuring the stability and reliability of different insurance systems.

Of late, insurance fraud detection has assumed immense significance owing to the huge financial & reputational losses fraud entails and the phenomenal success of the fraud detection techniques. Insurance is majorly divided into two categories: (i) Life and (ii) Non-life. Non-life insurance in turn includes health insurance and auto insurance among other things. In either of the categories, the fraud detection techniques should be designed in such a way that they capture as many fraudulent transactions as possible. Owing to the rarity of fraudulent transactions, in this paper, we propose a chaotic variational autoencoder (C-VAE to perform one-class classification (OCC) on genuine transactions. Here, we employed the logistic chaotic map to generate random noise in the latent space. The effectiveness of C-VAE is demonstrated on the health insurance fraud and auto insurance datasets. We considered vanilla Variational Auto Encoder (VAE) as the baseline. It is observed that C-VAE outperformed VAE in both datasets. C-VAE achieved a classification rate of 77.9% and 87.25% in health and automobile insurance datasets respectively. Further, the t-test conducted at 1% level of significance and 18 degrees of freedom infers that C-VAE is statistically significant than the VAE.

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