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Fraud and where are the big risks?

  • Nicola Jedrej
  • Cybersecurity Insights

The Expert Panel on Fraud, Error, Waste and Abuse met recently in Paris. The panel members discussed all types of “leakage” in the payment system and how prevalent this is in our industry.

This can take many forms from criminal intent to fraud and deceive insurers; to simply not being able to manage claims effectively through for example disjointed operational systems. The ways insurers deal with this varied greatly from each possible inaccurate claim being reviewed, no matter what the value. Whereas others had clear thresholds as to where this warranted further investigation. Fraudsters are getting even more innovative through the use of technology to create claims that are robust on the surface, but once investigated are simply complex scams. But the technology that defrauds us, also enables us to delve deeper into this claims. Social media allows people to create identities and stories that validate a claim, but conversely it gives investigators the leverage to probe deeper using this tool. Social media is part of our daily lives, but how much of a risk is this now?

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Not a great time to become a health minister