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7. Feedback by business sector
The following developments are based on a number of business sectors in which we have highlighted the implementation of anti-fraud measures. Naturally, these sector-specific cases are subject to the limitations inherent in the sectors concerned, as well as in the deliberately succinct developments made in this article. These anonymous sectoral case studies do not concern specific companies.
7.1 Implementation in the complementary healthcare sector
Mutual health insurers have only belatedly become aware of the financial and image implications of healthcare fraud. Today, however, this operational risk, which lies at the heart of a mutual's core business, is the focus of real attention in the implementation of internal control and risk management policies. The...
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Feedback by business sector
Conclusion
Bibliography
Websites
Direction nationale de la lutte contre la fraude (DNLF) website:
https://www.economie.gouv.fr/dnlf
Site about scams, site of the Brigade de repression de la délinquance astucieuse (BRDA) :
Standards and norms
- Risk management – guidelines (classification index X50-254). - ISO 31000 :2018 - Février 2018
- Risk management – risk assessment techniques (classification index: (20-300-3-9)). - ISO 31010 :2010 - Juillet 2010
- Quality management – Requirements (classification index: X50-131). - ISO 9001 :2015 - Octobre 2015
- Contrôle interne : une approche intégrée. - Référentiel COSO - 2013
Regulations
European Directive 2009/138/EC on insurance prudential regulation.
Article 313-1 of the French Penal Code on fraud.
Article L. 561-15 of the French Monetary and Financial Code on the fight against money laundering and terrorist financing, including fraud in the scope of alerts.
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