Insurance


The insurance industry is perhaps the largest victim of fraudulent activity in the economy.


Health Care Fraud

Health care fraud includes any scheme involving the health care industry that is designed for illegal financial gain. These schemes may include billing for services not rendered, inflating the cost of the service provided, the deliberate performance of medically unnecessary services, etc.

Perpetrators can include dishonest health card providers, physicians, dentists, chiropractors, hospitals, pharmacies, labs, nursing homes, medical equipment suppliers, or by the patients themselves.
False claim schemes are the most common type of health insurance fraud. Such schemes include any of the following when done deliberately for financial gain:
  • Billing for services, procedures, and/or supplies that were not provided.
  • Misrepresentation of what was provided; when it was provided; the condition or diagnosis; the charges involved; and/or the identity of the provider recipient.
  • Providing unnecessary services.
  • Charging for a service that was not performed.
  • Billing separately for procedures that normally are covered by a single fee
  • Double billing
  • Upcoding
  • Miscoding
  • Kickbacks
  • Etc
With an estimated fraud of ten percent of health care expenditure, the potential to benefit from an accurate and efficient fraud detection solution is huge and desperately needed.


Auto Insurance Fraud

Auto insurance fraud is dramatically on the increase. Non-profit sites like the Coalition Against Insurance Fraud report that auto insurance fraud costs over $12 billion or more each year. Auto insurance fraud schemes include any of the following:
  • STAGED ACCIDENTS
  • AUTO REPAIR SHOPS
    • Bill for work not performed
    • Over quote the work,
    • False claim for property stolen
    • Deliberately cause damage to the car and bill the insurance company.
    • False reporting a car as stolen
    • False hit-and-run claims
    • Destroying a vehicle by setting it on fire
    • Etc


Adaptive Fraud Prevention Solution

iPrevent delivers a comprehensive solution that not only identifies more fraud activities than any other solution, but also detects first fraud.

iPrevent accurately identifies suspicious and fraudulent behavior from seemingly normal claims regardless of whether this specific behavior has been previously identified.

With iPrevent, insurance providers can:
  • Reduce the incidence of false or inflated claims
  • More accurately identify suspicious claims
  • Adapt to new fraud methods
  • Improve profit margins with efficient use of investigative staff