The fight against health insurance fraud

The fight against complementary health insurance fraud is a major concern for the sector's actors.

Although measures have been put in place to detect and prevent fraud (data and expense monitoring, staff training in fraud recognition, implementation of secure payment systems), the supplementary health insurance players have lagged behind.

Indeed, the fight against fraud is a constant challenge: "Their techniques are becoming more professional, [the fraudsters] can act from abroad with an IP address that makes them think they are in France," explains Tanguy Le Nouvel, Micropole's Director of Data Science, in the Argus de l'Assurance's report: "The four pillars of the fight against fraud".

Fraudsters are evolving along with technology, they are becoming more professional and frauds are often sophisticated and difficult to detect. That's why health insurance companies need the best tools to fight against this scourge, and Artificial Intelligence is one of them: "We can only capitalize on frauds already identified if they have been qualified and listed in a database. Artificial Intelligence works better if we teach it to recognize suspicious cases" comments Tanguy Le Nouvel.

Find the complete file on the Argus de l'Assurance website by clicking on the button below.

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