Shift Technology, a provider of AI-native fraud detection and claims automation solutions for the global insurance industry published its latest analysis of the fraud trends being faced across the insurance industry. In Shift Technology Fraud Insights Vol. 2: November 2020, the company focuses in on the schemes driving Fraud, Waste, and Abuse (FWA) which impact health payers around the world.
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Industry estimates put the global impact of FWA on insurers and payers at more than $600 billion (500 Billion Euro) per year. Being able to effectively reduce these costs provides significant new opportunities to focus premiums on delivering impactful care, benefiting members and payers alike. For its latest report, Shift closely examines abusive activities perpetrated by unscrupulous opticians, which during the COVID-19 lockdown in France generated more than 300,000 Euro worth of potentially fraudulent claims. Further, the report explores network provider fraud schemes, issues associated with “medical tourism” and other challenges in international health insurance for travelers and expatriates, and fraud associated with underwriting and renewal. Shift also highlights how new approaches to subrogation detection can better identify those opportunities and inform decisions about coordination of benefits.