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1.
基于博弈理论,首先分析了农业保险欺诈风险及审计依据。其次,将参与人情绪因素嵌入博弈理论分析框架,获得了博弈双方欺诈或审计最优策略表达式,并进行相应的经济学解释。最后,从审计监督视角给出了反欺诈政策建议。结论显示,审计成本、情绪因素都对双方决策行为具有重要影响,审计效率越高,审计成本越低,农户情绪越悲观,则欺诈行为发生的可能性越小。  相似文献   

2.
从理论上讲,保险人和投保人总是处于欺诈和反欺诈的博弈之中,欺诈有收益也有成本,反欺诈需要成本支出也能获得收益。按照经济人的假定,保险人和被保险人在不完全信息的动态博弈中会达到一个均衡,在这个均衡点上双方的策略处于最优,这时的保险合同也是最优保险合同:部分保险。基于保险人和投保人双方最优博弈策略的保险合同形式不可能是足额保险,而只能是部分保险,其原理在于使得投保人和保险人共同承担保险标的的风险损失,以此来遏制和减少投保人的欺诈行为,一般而言,投保人承担的部分越大,其实施保险欺诈的动因和可能性就越小。这一原理在保险产品设计中的应用就是大量采用绝对免赔额、相对免赔额(率)和不足额保险三种方式。  相似文献   

3.
保险欺诈者的行动不仅受到违法成本的影响,也受到法律执行概率的影响。本文从分析保险欺诈者的效用和自身感受到的违法成本出发,研究违法者的行为动机和决策过程,为我国开展保险反欺诈工作和法制宣传教育工作提供对策和建议。  相似文献   

4.
证券欺诈是发生在资本市场中与证券发行和交易有关的欺诈性行为,是一种侵权法意义上的欺诈。反欺诈制度建设是本文研究的主要问题。不实陈述、内幕交易、欺诈客户和操纵价格四种类型的证券欺诈在主观上具有牟取非法利润或非法避免损失的动机,在客观上造成了其他投资者的合法权益受到损失,使得证券欺诈禁止制度在体系上呈现出相对的独立性。这种相对独立性要求对证券欺诈的禁止必须通过刑事、民事和行政多种调整手段加以规范和禁止。因此,设计证券欺诈禁止制度的出发点在于为市场提供一个经济和效率的司法救济模式,以促进市场的公正和稳定。本文借鉴美国、英国、日本等国的证券法规及其成功经验,通过比较法等研究方法探讨我国证券市场反欺诈制度存在的问题及其制度体系,对构建我国资本市场监管法律制度及其反欺诈制度,建立一个公平、公正、公开透明的规制体系,提出了建设性意见。  相似文献   

5.
大股东控制权收益的分享与控制机制研究   总被引:2,自引:0,他引:2  
大股东控制企业一方面有助于降低股东与经营者之间的代理成本,提高公司价值,另一方面也伴随着大股东对中小股东利益的掠夺。相应地,公司的控制权收益可以分为共享收益和私有收益两大部分。为限制控股股东对中小股东利益的掠夺,应当建立起激励相容的大股东与中小股东对控制权共享收益的分享机制,增加大股东对共享收益的分享份额,同时,通过完善独立董事制度、审计委员会制度、强化对大股东行为的法律约束机制等措施控制大股东对公司的掏空行为。  相似文献   

6.
信息披露制度变迁与欺诈管制   总被引:10,自引:0,他引:10  
何进日  武丽 《会计研究》2006,(10):18-22
在自愿信息披露制度下,资质优良、业绩不俗的公司有动力通过自愿信息披露突出自身竞争优势。本文具体分析了自愿信息披露行为作为一种信号传递机制必须满足的三个假设,即理性的管理者、知情投资者和真实信息披露;在自愿信息披露弱化的三种情况下,强制信息披露制度成为提升信息披露的必然手段,信息披露制度也由自愿向强制转变,但同时伴随信息披露制度的变迁产生了新的联合欺诈行为;因此,信息欺诈贯穿整个信息披露制度的变迁过程,无论强制披露制度还是自愿披露制度,其根本目的在于对信息欺诈的禁止,但欺诈并没有因制度的变迁而消失,所以解决信息欺诈的关键在于建立反欺诈管制,只有这样才能从根本上阻止信息欺诈的行为。  相似文献   

7.
作为有限理性的经济人,追求效益最大化是会计人员的基本行动动机。制度的缺失、环境的影响和自身对经济、政治利益的向往和追求可能导致有限理性的会计人员产生财务舞弊行为。只有通过降低财务舞弊的预期收益,提高诚信收益;提高财务舞弊的预期成本,降低诚信成本达到重组成本收益,有效抑制会计人员财务舞弊行为。  相似文献   

8.
本文基于公司行为的成本收益理论,对我国银行在短期内开展内部评级进行了成本收益的理论分析与实证预测,得出以下结论:现阶段我国个体银行内部评级成本大于收益,学习效应和规模经济效果不明显;银行内部公司治理机制的发展水平将影响到内部评级的成本收益;银行需要积极为内部评级创造良好的制度环境,缩短时间跨度使边际收益的增长速度加快.  相似文献   

9.
作为有限理性的经济人,追求效益最大化是会计人员的基本行动动机。制度的缺失、环境的影响和自身对经济、政治利益的向往和追求可能导致有限理性的会计人员产生财务舞弊行为。只有通过降低财务舞弊的预期收益,提高诚信收益;提高财务舞弊的预期成本,降低诚信成本达到重组成本收益,有效抑制会计人员财务舞弊行为。  相似文献   

10.
李玉泉  乔石 《保险研究》2021,(4):121-127
随着以互联网、大数据为核心的新科技的出现,在大金融背景下,保险欺诈呈现出新的特征.本文从保险欺诈的欺诈行为、实施者的主观过错、欺诈行为与保险赔偿之间具有因果关系这三个构成要件入手,详细分析了在金融活动相互融合以及互联网、大数据等科技手段广泛运用的当今时代下保险欺诈的三个新特征,并从健全保险欺诈法律法规体系、建立健全跨行业的反保险欺诈协作机制、建立整个保险行业的反欺诈数据一体化管理体系和夯实保险机构的反保险欺诈管理能力四个方面提出具体的保险欺诈防范路径.  相似文献   

11.
This paper provides a theoretical analysis of the benefits for an insurance company to develop its own network of service providers when insurance fraud is characterized by collusion between policyholders and providers. In a static framework without collusion, exclusive affiliation of providers allows insurance companies to recover some market power and to lessen competition on the insurance market. This entails a decrease in the insured’s welfare. However, exclusive affiliation of providers may entail a positive effect on customers’ surplus when insurers and providers are engaged in a repeated relationship. In particular, while insurers must cooperate to retaliate against a fraudulent provider under non-exclusive affiliation, no cooperation is needed under exclusive affiliation. In that case, an insurer is indeed able to reduce the profit of a malevolent provider by moving to collusion-proof contracts when collusion is detected, and this threat may act as a deterrent for fraudulent activities. This possibility may supplement an inefficient judicial system: it is thus a second-best optimal anti-fraud policy.  相似文献   

12.
The two main purposes of this paper are an introduction to the economic analysis of insurance fraud and furthermore a derivation of factors that determine fraudulent behavior of policyholders on insurance markets. Consequently, we analyze the strategic decision problems of insurance companies and the policyholders and identify some factors that can help to reduce fraudulent behavior. In this context we evaluate two derived starting points for the combat against insurance fraud: fraud detection systems and a consequent charge policy of detected defrauders. We illustrate that both points can help to reduce the cost of fraud. Furthermore, we enhance our earlier analysis with respect to the empirical fact that some individuals care about fairness or — in the insurance fraud context — the legitimacy of their actions. Surprisingly, in some market situations these concerns of some policyholders do not lead to a lower fraud probability. Finally, we discuss how and to what extent insurance companies can influence such ethical concerns of policyholders. On that score, we distinguish insurance specific and insurance unspecific factors and their impact on the consumers attitudes towards insurance fraud.  相似文献   

13.
本文通过对台湾保险业反欺诈工作情况、保险业资金运用政策与现状、金融业综合经营与金控公司的发展、保险行业组织的发展与作用等重要问题的考察,借鉴台湾保险业的经验和教训,提出应建立两岸保险反欺诈合作机制,在大陆逐步建立行业性保险犯罪信息数据库,进一步发挥行业组织在反保险欺诈工作中的作用,加强反保险欺诈国际交流,稳步推进费率市...  相似文献   

14.
Theoretical research examining how to fight insurance fraud is usually based on the assumption that individuals behave purely selfish and maximize expected utility from monetary payoffs. Therefore, this research does not take into account that insurance fraud constitutes an illegal behavior that some individuals never commit, e.g., due to ethical reasons. This article presents experimental findings on factors that influence fraudulent behavior of infrequent offenders. The results show that some subjects never commit fraud in the experiment, although it would have been financially profitable. Deductible contracts lead to an increase of fraudulent behavior. In contrast, information regarding other subjects’ claiming behavior does not have any significant impact on the probability to commit fraud. Therefore, in our experiment social interaction only induces minor changes in behavior.  相似文献   

15.
The insurance industry is concerned with the detection of fraudulent behavior. The number of automobile claims involving some kind of suspicious circumstance is high and has become a subject of major interest for companies. This article demonstrates the performance of binary choice models for fraud detection and implements models for misclassification in the response variable. A database from the Spanish insurance market that contains honest and fraudulent claims is used. The estimation of the probability of omission provides an estimate of the percentage of fraudulent claims that are not detected by the logistic regression model.  相似文献   

16.
The German Insurance Association estimates a yearly amount of damage of € 1.5?bn to German motor vehicle insurance companies because of systematic fraud by insurance holders. It is supposed that about 10% of submitted claim applications contain manipulated data, therefore insurance companies are forced to complete a detailed and cost intensive case-by-case review of each single application. An alternative method to detect fraud in empiric data is the method of digital analysis based on Benford’s law. The Benford method uses a mathematical law of specific logarithmic distribution attributes of first digits. According to this approach, the data of a Benford set confirm with the expected digit distribution, if the data is not manipulated, whereas fraudulent interventions lead to a deviation from Benford’s law. Hence, until now there has not been any investigation whether the Benford method can also be applied on insurance data. The present article analyses a dataset consisting of more than 120,000 damage claim applications to answer this question as well as to identify the impact of specific characteristics on the probability of fraud contained in claim applications, such as the repair of the vehicle in a franchised or an independent workshop, the vehicle brand or the examination by insurance companies experts. Indeed it could be shown that Benford’s Law is only applicable on second digits of insurance data, but delivers very strong results here: All results of the considered characteristics could be verified by plausible arguments. For this reason insurance companies can benefit from making use of the Benford method to identify those claim applications with a high probability of fraud, which should then be reviewed in more detail so that resources can be allocated in a much more cost efficient way.  相似文献   

17.
公平普惠是我国卫生和健康事业建设的目标,基本医疗保险是实现目标的制度保障。本文基于安德森医疗服务利用行为理论,采用三阶段随机抽样方法采集湖北省少数民族贫困县965个农村参保者的调查数据,通过收入五等分法、二元选择模型和两部分模型对基本医疗保险受益公平性进行分析。结果发现:均等化的医疗保险政策不仅实现了规则公平,实践中也提高了低收入参保者的医疗服务利用行为,即低收入组与高收入组有相似的就诊行为,且最低收入组比最高收入组还有更高的报销可能性。但是从医疗服务利用结果和疾病经济负担来看,低收入者仍然处于劣势。最低收入组和较低收入组均比最高收入组有更高的慢性病患病可能性和更差的自我健康评价,同时低收入组有着更重的疾病经济负担。此外,少数民族居民、失业者、年长者、有配偶的居民可能有更差的医疗服务利用结果。因此,中国在实现全民医保的基础上,未来还要进一步提高医保受益公平性。  相似文献   

18.
互联网保险特殊经营模式使保险公司呈现固定资产占比较小、资产负债率较低、保险产品"场景化、碎片化"、渠道成本低廉等财务特征,也使保险公司面临更为错综复杂的财务风险,如对股东的权益性资金依赖性较强、定价风险加大、盈利空间不定以及骗赔套保和洗钱风险等.鉴此,应拓宽筹资渠道,优化保险产品定价,提高保费收入持续增长能力,降低运营和合作成本,构建第三方保单认证和风险评估体系,加强资金规范化管理,强化外部监管等.  相似文献   

19.
Each year health care fraud drains millions of dollars from employer-sponsored health plans. Historically, employers have taken a rather tolerant view of fraud. As the pressure to manage health plan costs increases, however, many employers are beginning to see the detection and prosecution of fraud as an appropriate part of a cost management program. Fraud in medical insurance covers a wide range of activities in terms of cost and sophistication--from misrepresenting information on a claim, to billing for services never rendered, to falsifying the existence of an entire medical organization. To complicate matters, fraudulent activities can emanate from many, many sources. Perpetrators can include employees, dependents or associates of employees, providers and employees of providers--virtually anyone able to make a claim against a plan. This article addresses actions that employers can take to reduce losses from fraud. The first section suggests policy statements and administrative procedures and guidelines that can be used to discourage employee fraud. Section two addresses the most prevalent form of fraud--provider fraud. To combat provider fraud, employers should set corporate guidelines and should enlist the assistance of employees in identifying fraudulent provider activities. Section three suggests ways to improve fraud detection through the claims payment system--often the first line of defense against fraud. Finally, section four discusses the possibility of civil and criminal remedies and reviews the legal theories under which an increasing number of fraud cases have been prosecuted.  相似文献   

20.
保单贴现是一种投资者以折扣价买进即将到期的人寿保单,到期获得保险公司给付的保险金,同时解决了绝症患者和老年病患高额医疗费的需要,以及老年人养老费用的需要,这是一种多赢的投资工具,在国外发达国家已经存在多年,并发展越来越快;随着我国金融市场的开放和人们保险意识的加强,发达国家保单贴现业务值得我国借鉴,尽快推出这一创新的保险业务,以满足部分保单持有人提前变现保单的需求。  相似文献   

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