According to some experts in the health insurance industry, the major factor that affects increase of health care cost is fraudulent claims that are made every year. To prevent theses trickeries, big insurance companies are encouraged to utilize the most innovative technology to assist them determining and eliminating deceitful claims.

Paul Power, a director for a software firm that provides anti-fraud packages to the insurance industry believes that the current downturn in the economical market has been a factor in the rise of ‘opportunistic fraud’. He said, “The difficulty is that insurance providers need to identify very subtle behaviors that are masked by enormous amounts of data that stream in on a continuous basis. Thanks to advances in predictive analytics, there are now solutions that enable insurers to make accurate claims decisions, before claims are paid out.”

Based on a research, medical specialists are the worst offenders when it comes to overcharging for procedures, with the most common type of healthcare fraud being ‘up-coding’. Further fraudulent practices include over-treatment, where a provider has billed for treatments that were not medically required and misrepresenting, which sees a claimant omit or overstate their medical complaints.

One of the founding members of the Health Insurance Counter Fraud Group (HICFG), Dr Simon Peck said, “Healthcare fraud affects all healthcare systems. Our own research in Britain indicates that fraud related losses could account for 5 per cent of policyholders’ premiums, and possibly more than that. In the US, the cost of healthcare fraud is thought to be $150 billion (€100 billion). What is important is that insurance companies get together and share information.”