Health Insurance Fraud

Objective Insurance frauds cover the range of improper activities which an individual may commit in order to achieve a favorable outcome from the insurance company. The insurance industry has grappled with the challenge of insurance claim fraud from the very start. Improper payouts cause a hit to profitability and encourage similar delinquent behavior from other policy holders.

Other Frauds

Eligibility Fraud – Policyholders commit this fraud by providing false details about them to be eligible for the policy. They provide wrong information about their  pre-existing diseases, employment status, dependent, etc.

Application Fraud – Policyholders commit this fraud by entering wrong details in the application form about the diseases they suffer from, claims, etc., to get extra benefits. For example – Some policyholders write wrong information about the diseases to avail extensive coverage.

Deployment

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The model