Fraud Risk Management in Organizations by using Artificial Intelligence

Fraud management has become a major concern for companies and organizations in general, faced with a sharp increase in this phenomenon in many sectors. For example, according to certain studies (Health Insurance, sector studies), fraud involving complementary health organizations increased by more than 181% between 2023 and 2024. According to interviews conducted by the authors in 2023 and 2024, such a trend has also been confirmed in other areas: in the credit granting field, fraudulent transactions, often relying on false documents as well as real documents but as part of identity theft schemes, are now highly prevalent schemes. In the telecoms sector, the use of false bank details to obtain a telephone with the purchase of a package has also become a very common scheme. In the housing and rental sector, it is no longer uncommon to find files incorporating "partially falsified" elements (e.g., increased income to guarantee validation of a file).

Faced with the increase in this phenomenon, the various sectors have gradually been able to structure an anti-fraud approach by implementing real anti-fraud strategies . These strategies may focus on employee training to improve detection , or on internal and external communication to prevent and detect the highest-risk situations, involving both internal stakeholders (employees involved in operations) and external stakeholders (customers who may be exposed to fraud, suppliers), with a view to cross-ownership by all .

In addition, the most mature organizations have gradually developed genuine anti-fraud processes focusing on prevention (to avoid fraudulent payments), detection (to detect attempted or actual frauds as quickly as possible) and reaction (incident response). These processes are structured around committees dedicated to the fight against fraud, dashboards incorporating a battery of indicators monitored at regular intervals, human resources (fraud analysts), external relays (brigades dedicated to fraud on the side of the forces of law and order), but also internal requests...