Have you ever wondered what cost the insurance industry pays when a health claim fraud detection has been made? Well, billions! In fact, In India, health insurance comes at a staggering cost of billions of rupees every year. 60 percent of Indian insurers see a rapid rise in Insurance fraud. Health insurance fraud contributes to one of the facets of this huge insurance fraud number. Millions fall prey to deceitful health insurance situations that make them the victims of insurance fraud. However, insurers today are adapting to smart insurance technology solutions to effectively combat health insurance fraud. There are different examples of health frauds that need efficient fraud detection software that can detect any type of health insurance fraud.
Hop on to the next section to explore more!
Types of Health Insurance Frauds
As insurers continue to grapple with different healthcare fraud cases, it is important to know the different types of health insurance fraud to better understand the insurance fraud scenario in the healthcare sector. Here are the common types of health insurance frauds:
Application Fraud
This is health insurance fraud, which includes intentionally giving false information on a health insurance application.
Claim Fraud
This is a type of health insurance fraud when the policyholder files a false or inflated claim for medical expenses. Examples of health frauds of this kind include submitting bills of services that were never received, dramatizing the severity of a condition or even faking a medical incident
Billing Fraud
Health insurance billing fraud is when the insurer charges you for services that were not rendered. This includes inflating the charges for services, or any upcoming procedures.
Multiple Policy Fraud
In health insurance fraud, an individual purchases multiple health insurance policies from different insurers without informing any of the insurers. They then file a claim for each one of the insurers hoping to get multiple policy benefits.
Deliberate Fraud
In this health insurance fraud, an individual intentionally deceives an insurance company to extract financial profit. This is a planned and purposeful act which is quite different from accidental errors or misunderstandings.
Eligibility Fraud
In these types of healthcare fraud cases, the policyholder misinterprets the information intentionally on the application or during the claims process to gain more coverage or benefit. Most of the time this health care insurance fraud happens in order to show eligibility to get the policy or claim.
How Insurance Technology is Changing the Health Insurance Fraud Detection Ecosystem?
Advanced software solutions and AI in insurance are changing the health insurance fraud detection ecosystem. 96% of insurers in the United States use insurance technology for detecting fraudulent claims.
Stay ahead in claims fraud detection with these insurance technology solutions:
Explore Policyholder Behavioral Patterns with Advanced Analytics
Insurers can use Behavioral analytics; this is a new insurance technology tool that they can put to use to detect health insurance fraud. This tool will clarify the policyholder’s behavioral pattern by providing insights into people’s actions by tracking and interpreting their browsing history, clicks, location, and more. This will help the insurers to determine whether the policyholder’s claims are trustworthy.
Assessing the Cost of Loss with Computer Vision
Computer Vision is a powerful AI in insurance automation type that insurers can use to assess the cost of actual loss. These computer vision models are capable of assessing the cost of loss by assessing images and videos. This will help the insurance company to get an idea of the actual medical expense that the policyholder has had and then enable them to utilize the policy benefits accordingly.
Photo Analysis Technology
Insurers can use photo analysis technology to detect health insurance fraud. They can leverage the photo analysis technology in the claims adjustment process to verify the images that are uploaded in support of the claims
How iNube can Help?
iNube understands the impact that health insurance frauds have on the insurer and the policyholder. Keeping that in mind, iNube’s advanced health claims management system is designed to effectively detect fraudulent claims in the claims processing processes. Additionally, experience the power of automation in insurance fraud detection with iNube’s AI Quest- the labs wing of iNube.
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Contact our insurance technology expert today!
