IDEAS home Printed from https://ideas.repec.org/p/hal/journl/hal-03336033.html
   My bibliography  Save this paper

External Fraud Risk Management seen from Luhmann’s Systemic Perspective and a Tentative Reading of Healthcare Insurance Companies’ Measures through this Perspective

Author

Listed:
  • Emmanuel Laffort

    (CREG - Centre de recherche et d'études en gestion - UPPA - Université de Pau et des Pays de l'Adour)

  • Nicolas Dufour

    (PSB - Paris School of Business - HESAM - HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université)

Abstract

This research explores the contribution of Niklas Luhmann's radical systemic sociology to External Fraud Risk Management. To do this, we use two Luhmannian distinctions — between risk and danger, and between confidence and trust — to verify their (in)validity based on two empirical studies on Healthcare Insurance Companies (HIC) to reduce the risk of external fraud. This study concludes that the Luhmannian framework is relevant for external fraud management issues.

Suggested Citation

  • Emmanuel Laffort & Nicolas Dufour, 2020. "External Fraud Risk Management seen from Luhmann’s Systemic Perspective and a Tentative Reading of Healthcare Insurance Companies’ Measures through this Perspective," Post-Print hal-03336033, HAL.
    • Handle: RePEc:hal:journl:hal-03336033
    DOI: 10.3917/resg.138.0263
    Note: View the original document on HAL open archive server: https://hal.science/hal-03336033
    as

    Download full text from publisher

    File URL: https://hal.science/hal-03336033/document
    Download Restriction: no
    File URL: https://libkey.io/10.3917/resg.138.0263?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Elka Johansson & Peter Carey, 2016. "Detecting Fraud: The Role of the Anonymous Reporting Channel," Journal of Business Ethics, Springer, vol. 139(2), pages 391-409, December.
    2. Mikes, Anette, 2011. "From counting risk to making risk count: Boundary-work in risk management," Accounting, Organizations and Society, Elsevier, vol. 36(4), pages 226-245.
    3. Georges Dionne & Kili Wang, 2013. "Does insurance fraud in automobile theft insurance fluctuate with the business cycle?," Journal of Risk and Uncertainty, Springer, vol. 47(1), pages 67-92, August.
    4. Alain Cohn & Ernst Fehr & Michel André Maréchal, 2014. "Business culture and dishonesty in the banking industry," Nature, Nature, vol. 516(7529), pages 86-89, December.
    5. Pamela Murphy & M. Dacin, 2011. "Psychological Pathways to Fraud: Understanding and Preventing Fraud in Organizations," Journal of Business Ethics, Springer, vol. 101(4), pages 601-618, July.
    6. Stijn Viaene & Guido Dedene, 2004. "Insurance Fraud: Issues and Challenges," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 29(2), pages 313-333, April.
    7. Caplan, D, 1999. "Internal controls and the detection of management fraud," Journal of Accounting Research, Wiley Blackwell, vol. 37(1), pages 101-117.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Emmanuel Laffort & Nicolas Dufour, 2021. "Prise en compte de la fraude dans les organisations : comment libérer la parole ?," Post-Print hal-03336041, HAL.
    2. Monica Ramos Montesdeoca & Agustín J. Sánchez Medina & Felix Blázquez Santana, 2019. "Research Topics in Accounting Fraud in the 21st Century: A State of the Art," Sustainability, MDPI, vol. 11(6), pages 1-31, March.
    3. Haithem Zourrig & Jeongsoo Park, 2019. "The effects of cultural tightness and perceived unfairness on Japanese consumers’ attitude towards insurance fraud: the mediating effect of rationalization," Journal of Financial Services Marketing, Palgrave Macmillan, vol. 24(1), pages 21-30, June.
    4. Florian Hoos & Grégoire Bollmann, 2012. "Is accountability a double-edged sword? Experimental evidence on the effectiveness of internal controls to prevent fraud," Metrika: International Journal for Theoretical and Applied Statistics, Springer, vol. 23(2), pages 115-132, November.
    5. Jennifer Kunz & Mathias Heitz, 2021. "Banks’ risk culture and management control systems: A systematic literature review," Journal of Management Control: Zeitschrift für Planung und Unternehmenssteuerung, Springer, vol. 32(4), pages 439-493, December.
    6. Galeotti, Marcello & Rabitti, Giovanni & Vannucci, Emanuele, 2020. "An evolutionary approach to fraud management," European Journal of Operational Research, Elsevier, vol. 284(3), pages 1167-1177.
    7. J. Reed Smith & Samuel L. Tiras & Sansakrit S. Vichitlekarn, 2000. "The Interaction between Internal Control Assessment and Substantive Testing in Audits for Fraud," Contemporary Accounting Research, John Wiley & Sons, vol. 17(2), pages 327-356, June.
    8. Girardone, Claudia & Kokas, Sotirios & Wood, Geoffrey, 2021. "Diversity and women in finance: Challenges and future perspectives," Journal of Corporate Finance, Elsevier, vol. 71(C).
    9. Lamar Pierce & Jason Snyder, 2015. "Unethical Demand and Employee Turnover," Journal of Business Ethics, Springer, vol. 131(4), pages 853-869, November.
    10. Christian Hauser, 2019. "Fighting Against Corruption: Does Anti-corruption Training Make Any Difference?," Journal of Business Ethics, Springer, vol. 159(1), pages 281-299, September.
    11. Palermo, Tommaso, 2014. "Accountability and expertise in public sector risk management: a case study," LSE Research Online Documents on Economics 59948, London School of Economics and Political Science, LSE Library.
    12. Tuan Zainun Tuan Mat & Danny Shahmizi Teh Ismawi & Erlane K Ghani, 2019. "Do Perceived Pressure and Perceived Opportunity Influence Employees¡¯ Intention to Commit Fraud?," International Journal of Financial Research, International Journal of Financial Research, Sciedu Press, vol. 10(3), pages 132-143, May.
    13. Appelgren, Leif, 2020. "A survey of models for determining optimal audit strategies," Advances in accounting, Elsevier, vol. 48(C).
    14. Vicky Arnold, 2018. "The changing technological environment and the future of behavioural research in accounting," Accounting and Finance, Accounting and Finance Association of Australia and New Zealand, vol. 58(2), pages 315-339, June.
    15. Baumberg, Ben, 2016. "Benefit `myths'? The accuracy and inaccuracy of public beliefs about the benefits system," LSE Research Online Documents on Economics 103512, London School of Economics and Political Science, LSE Library.
    16. Avichai Snir & Dudi Levy & Dian Wang & Haipeng Allan Chen & Daniel Levy, 2024. "Large Effects of Small Cues: Priming Selfish Economic Decisions," Papers 2405.03893, arXiv.org.
    17. Josef Hollmayr & Michael Kuehl, 2016. "Imperfect Information about Financial Frictions and Consequences for the Business Cycle," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 22, pages 179-207, October.
    18. Ahrens, Steffen & Bosch-Rosa, Ciril, 2023. "Motivated beliefs, social preferences, and limited liability in financial decision-Making," Journal of Banking & Finance, Elsevier, vol. 154(C).
    19. Austin, Chelsea Rae & Bobek, Donna D. & Jackson, Scott, 2021. "Does prospect theory explain ethical decision making? Evidence from tax compliance," Accounting, Organizations and Society, Elsevier, vol. 94(C).
    20. Asunur Cezar & Huseyin Cavusoglu & Srinivasan Raghunathan, 2014. "Outsourcing Information Security: Contracting Issues and Security Implications," Management Science, INFORMS, vol. 60(3), pages 638-657, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hal:journl:hal-03336033. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CCSD (email available below). General contact details of provider: https://hal.archives-ouvertes.fr/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.