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1 ),,,. (N ICB), (CAIF),, (IRC : Insurance Research Cou ncil), III(In surance Inform ation Institu te), CAIF, Connin g & Com p any. Conning Conning frau d Survey 46) - (IRC). Conning s Survey (property-casualty comp anies) (life-health companies).. 47) (violent crime), (economic crim e) 45) 1996 Conning F raud S urvey. Conning Insurance Research & Publications, Insurance F raud- The Quiet Catastrop he ) < 3>. Con nin g' s Su rvey. 47) Con nin g & Com p any, Insuran ce Fraud- The Quiet Catastrophe, p
2 (social crim e)... (intensity) ). < 2> (as sault ) (m urder ) (rape) (robbery ) (ar son ) (burglary ) (em bezzlem ent ) (forgery ) (Fra ud), (theft ) (Loitering ) (w eapons ) : Con nin g & Com p any, p ) M others A gain st Dru nk Drivers(MADD)", "Don 't Be a Litter Bu g". Connin g & Com p any, p
3 ,,,.., (p adding)..... Conning's Survey. < 3> / Sem i-. 1)
4 . 80%, %. < 1>. 2) 74%, - 64%.. FBI Uniform Crim e Report , , %
5 18.2%., 49) Conning s Survey ( 71%, - 88%) 3. 50) < 1> < 2> < 3>. < 2>? 49),. 50) Con nin g In su r ance Research & Pu blication s, Insurance Fraud- The Quiet Catastrophe p
6 .,.,. Conning. < 3> 3?
7 . IRC 28%(1995) 40%(1997) (deductible) (claim pedding, ), 24%(1995) 36%(1997).,. 51) CAIF %, )., 25% 250, < 4> (1994) 24,074,261 6,018,565 $1,504,641,300 : ISO, A.M. Best, Connin g & Com p any. 51) Connin g & Com p an y, p.25 ; In su rance Inform ation In stitu te, Insurance Issues update, ) III, p
8 32%, (withholding information), 53), 20%. < 5> 21.,. 32 % 32 % 28 % 23 % 21% 21% 20% 14 % 12 % 11% 9 % 8 % 6% 5 % : In su ran ce Research Cou ncil, Con nin g & Com p any, p.27,. 53) IRS
9 ,,. < 6> % (withholding information) (ded u ctible) 26% 22 % 25 % 16% 25 % 21% 19 % 18 % 12 % 32 % 29 % 28 % 26% 20% 34 % 30% 26% 23 % 19 % 29 % 24 % 18 % 22 % 15 % 29 % 24 % 22 % 24 % 12 % 32 % 24 % 17% 26% 14 % 20% 16% 13 % 14 % 11% 20% 17% 16% 13 % 9 % : In su ran ce Research Cou ncil, Con nin g & Com p any, p.28, CAIF 31%, 22%, ( ) 26%. 54),, (44 ) 55). 54) In su r an ce Inform ation In stitu te, p ) 39. Insurance Information Institute, p
10 . (de d uc tible) 3. (deductible) 56),,. 57). Conning 43%, 29%. 83%, 88%.. 56)..,,, 1999, p.1. 57),
11 < 4>. < 5>?
12 . 3 ( ) 58). - 40%. < 6>. 58) (extern al frau d) (, ). (intern al frau d),
13 < 7>. 83% - 92% %, 28%.. 33% (major to m oderate problem), 21%
14 -. < 8>? < 9>?
15 . (S IUs ). 3 1, 3 1, ) (Special Investigative Units, SIUs).. IRC SIU % % Conning % SIU. - SIU. - SIU 48% 68%. 60) SIUs 75% SIUs, (International Association of Sp ecial Investigative Units, IASIU) 61) , %. IASIU % 59) Con nin g & Com p any, p p ) 1995 ICA (In tern ation al Claim A ssociation) 68 % SIU, Connin g 48 %. ICA Conn in g. 61) 95 %
16 . SIUs. SIUs. SIUs. 9. SIUs. 62) Conning 75%, - 48% SIUs. SIUs. < 7> S IU Fu ll-tim e < > $1,365,500 $956, % 33 % 12 % 3 % 76% 8% 8% 8% 43 % 32 % 16% 3 % 6% 40% 40% 0% 10% 10% 43 % 30% 62). SIUs
17 SIUs 10, % 44%. SIUs ). 1,200. (health care) 950, (property-casu alty) (life-disability) 50. (health care), ( ) (w orkers' compensation),,,. Conning, ) Con nin g & Com p any, p
18 < 8> / PPO* H MO s**/ POS*** ) * PPO (p referred p rovider organization s) : ** H MO (health m ainten ance organization s) : *** POS(p oint-of service p lan ) : IRC ), (padded claim) 79%, 66%, 64%, 62%, 53%.. 64) 1978, 1981, 1983,
19 ) ( ). / ( : 72%). 12 ( ) , ( : 77%).,,,..,. 64),,. ( ) ( ), ( 99 )
20 < 9> (%) (, ) ( ) ( ) : 5 ( ) (,,, ), ( ), %, 78.4%
21 . ( ) 80.2% 85.0%. ( : ) 82.1%, 69.9%., 3 (, ). ( )
22 < 10>
23 . 1). 35.9%, 15% Conning 80%, - 52%,.. < 11> ( )
24 2).., 67.1% 57.2%. 72%, 26%, 64%, 36%. < 12>
25 2.,. 3). (TV,, ). 26.0% 53.4%. 53.4%, 47.4%. < 13>
26 . 1) 61.7%, 19.2%, 13.7%,. 33%. CAIF %, 22%, ( ) 26%. 65) 2) ( ). (32.4%) (47.7%). CCAIF (1996) 43% 47%.,. 65) In su r an ce Inform ation In stitu te, Insurance Issues Update,
27 < 14>, 87%, 74%, 66%. 23%, 16%
28 < 15> `, 71.5% 13.9%. CCAIF (1996)? 78%.. 1)
29 .., 84.1%, (8.9%) (3.8) (12.7%). < 16> ( )
30 13.1% 50.3%, 24.8%.? 6.7%. 2),,, % 21.6%. 48.4%, 32.0% 80.4%. 3 (,, ) 3.0%
31 < 17>. 1) %, ( 20.1%, 12.3%),
32 (11.9%).,. (8.3%), (8.2%), (6.4%).. < 18> < > * :
33 , 5, (78.3%), (76.5%), (75.0%), (69.3%), (66.4%).. 3 (,,, ),. < 19> < > * :
34 2), 77%. 13%, 8%, 2% CAIF 63%, 15%, 7%, 3%, 2%. < 20>
35 3) (de ductib le) (deductible). 46.4%. IRC 22%(1993), 28%(1995), 40%(1997), Conning 43%, 29%. < 2 1>
36 4) 82.9% 6.6%. < 22>. 1) /.., 57.2%, 12.5%. 2)
37 . 48.0% 15.8%. 67.8% 9.2%..,, % 6.6%. < 23>
38 3.,,,,.,...,.. (padding)
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