Insurance Fraud Prevention - 6th ISACA Athens Conference PowerPoint timesaver – September 2011...

download Insurance Fraud Prevention - 6th ISACA Athens Conference PowerPoint timesaver – September 2011 2012: Ενδεικτικά Αποτελέσματα για την Απάτη από

of 37

  • date post

    17-Mar-2018
  • Category

    Documents

  • view

    216
  • download

    3

Embed Size (px)

Transcript of Insurance Fraud Prevention - 6th ISACA Athens Conference PowerPoint timesaver – September 2011...

  • 2013 Deloitte Touche Tohmatsu Limited

    Insurance Fraud Prevention

    Partner, Insurance Leader

    , 2013

    1

  • 2013 Deloitte Touche Tohmatsu Limited

    &

    2012:

    Deloitte.

    Deloitte.

    2

  • 2013 Deloitte Touche Tohmatsu Limited

    (ISA 240) :

    ( ,

    , ) ,

    3

  • 2013 Deloitte Touche Tohmatsu Limited

    4

    / ,

    /

  • 5 Deloitte PowerPoint timesaver

    September 2011

    &

  • 2013 Deloitte Touche Tohmatsu Limited

    , . .

    /

    .

    , . . (Past Posting).

    :

    : , .

    O . .

    : , , . , .

    :

    : () .

    : , .

    6

  • 2013 Deloitte Touche Tohmatsu Limited

    , .

    , .

    ,

    , , , .

    , , ,

    7

  • 8 Deloitte PowerPoint timesaver

    September 2011

    2012:

  • 2013 Deloitte Touche Tohmatsu Limited

    9

    UK

    Figures from the Association of British Insurers (ABI) show that:

    Despite insurers detecting more fraud, it is estimated that around 1.9bn (2.2bn) of fraud goes undetected each year.

    I nsurers are detecting more fraud the value of detected fraud in 2011 rose 7%

    I n 2011 insurers uncovered 138.814 fraudulent insurance claims

    equivalent to 2.670 claims every week up 5% on 2010.

    The value of savings for honest customers from detected frauds

    represented 5.7% of all claims, compared to 5% in 2010.

    Sweden Figures from Insurance Sweden reveal that: Insurance fraud investigators, established by insurance

    companies, conducted 6.200 investigations into suspected fraud in 2011 and detected a total of 40m of fraud.

    A study found that 1020% of all fraudulent claims are claims for losses arising from events that never occurred (i.e untruthful claims) and 8090% of all fraudulent claims are exaggerated claims.

  • 2013 Deloitte Touche Tohmatsu Limited

    10

    France

    Figures from the insurance association (FFSA) reveal that 35.042 fraudulent

    insurance claims were recorded in 2011, leading to 168m not being paid out

    to dishonest individuals.

    Finland A study of 1.000 adults conducted by the insurance association (FFI) in 2012 found that 27% said they knew a person who has deceived his/her insurance company. This figure is up from 25% in a similar study in 2010.

    Germany

    A study conducted by the insurance association (GDV) concluded that more than half of all claims arising from loss or damage to smartphones or tablet PCs could not have arisen and therefore must have been fraudulent to some extent.

  • 2013 Deloitte Touche Tohmatsu Limited

    (Coalition Against Insurance Fraud)

    ..

    : Data Analytics Forecast Report, National Insurance Crime Bureau, https://www.nicb.org/newsroom/news-releases/mid-year-2012-qc-report.

    NICB-

    11

    7 !!!!!!!

  • 2013 Deloitte Touche Tohmatsu Limited

    ,

    /

    ,

    : Data Analytics Forecast Report, National Insurance Crime Bureau, https://www.nicb.org/newsroom/news-releases/mid-year-2012-qc-report.

    NICB -

    12

  • 13 Deloitte PowerPoint timesaver

    September 2011

    Deloitte

  • 2013 Deloitte Touche Tohmatsu Limited

    o 2012

    .

    .

    .

    14

  • 2013 Deloitte Touche Tohmatsu Limited

    ;

    ;

    ;

    15

  • 2013 Deloitte Touche Tohmatsu Limited

    ;

    ;

    ;

    16

    N

    N

  • 2013 Deloitte Touche Tohmatsu Limited

    ;

    ;

    ;

    17

  • 2013 Deloitte Touche Tohmatsu Limited

    ;

    ;

    , ;

    18

    /

  • 2013 Deloitte Touche Tohmatsu Limited

    /

    (Fraud management)

    .

    500

    -

    19

  • 2013 Deloitte Touche Tohmatsu Limited

    ,

    ' '

    & (Special Investigation Unit)

    20

    /

  • 2013 Deloitte Touche Tohmatsu Limited

    (analytics tools) ,

    ,

    21

    /

  • 22 Deloitte PowerPoint timesaver

    September 2011

  • 2013 Deloitte Touche Tohmatsu Limited

    , , 51 , , .

    51 % . ( 2012)

    . 30/10/2013.

    53%

    29%

    18%

    53%

    47%

    .

    23

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    ;

    ;

    24

    59%

    41% NAI

    OXI

    65%

    35%

    NAI

    OXI

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    (1-, 2-, 3-, 4-, 5-).

    25

    0

    1

    2

    3

    4

    5

    . .

    .

    .

    (

    )

    . ,

    .

    .

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    ,

    , .

    .

    26

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    90%

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    ;

    ;

    27

    53%

    47% NAI

    OXI

    82%

    18%

    NAI

    OXI

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    ;

    /

    ,

    ;

    28

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    . .

    (

    )

    .

    0%

    5%

    10%

    15%

    20%

    25%

    30%

    35%

    40%

    . . .

    . .

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    ;

    ;

    29

    41%

    59%

    NAI

    OXI

    35%

    65%

    NAI

    OXI

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    ;

    30

    0%

    5%

    10%

    15%

    20%

    25%

    .

    .

    .

    .

    .

    /

    .

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    whistle

    blowing;

    ;

    31

    53% 41%

    6%

    NAI

    OXI

    82%

    18%

    NAI

    OXI

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    2 ,

    ;

    ,

    ?

    32

    0%

    5%

    10%

    15%

    20%

    25%

    30%

    35%

    40%

    0%

    5%

    10%

    15%

    20%

    25%

    30%

    35%

    40%

    . . . .

  • 2013 Deloitte Touche Tohmatsu Limited

    Deloitte.

    33

    82%

    18%

    , ;

    NAI

    OXI

  • 2013 Deloitte Touche Tohmatsu Limited

    (Fraud Risk)

    34

  • 2013 Deloitte Touche Tohmatsu Limited

    -

    Antifraud /

    (Fraud Awareness Training)

    Whistleblowing

    35

  • 2013 Deloitte Touche Tohmatsu Limited

    (, , ..)

    :

    (data analytics)

    (data analytics)

    !!!

    36

  • Deloitte Greece is a member of Deloitte Touche Tohmatsu Limited (DTTL), a private UK company limited by guarantee, whose member

    firms are legally separate and independent entities. With a presence in more than 150 countries and about 200,000 professionals, all

    committed to becoming the standard of excellence, Deloitte provides audit, tax, consulting, and financial advisory services to public and

    private clients spanning multiple industries and brings world-class capabilities and high-quality service to clients, delivering the insights

    they need to address their most complex business challenges. Please see www.deloitte.com/about for a detailed description of the legal

    structure of DTTL and its member firms.

    In Greece, Deloitte Hadjipavlou Sofianos & Cambanis S.A. provides audit services, Deloitte Business Solutions Hadjipavlou

    Sofianos & Cambanis S.A. financial advisory, tax and consulting services and Deloitte Accounting Compliance & Reporting

    Services SA accounting outsourcing services. With a staff of about 500 and offices in Athens and Thessaloniki, Deloitte Greece focuses

    on all major industries including financial services; shipping; energy; consumer business; life sciences & health care and public sector

    services. Deloitte clients include most of the leading private and public, commercial, financial and industrial companies. For more

    information, please visit our website at www.deloitte.gr

    3a Fragoklissias & Granikou str., 151 25 Maroussi, Athens Greece, Tel: +30 210 6781 100

    2013 All rights reserved.

    http: