FRAUD: A PROBLEM TROUBLING INSURANCE INDUSTRY

Suryakant P. Parwat; Aslesha Parwat�Mukadam; Dr. Pramod Deo

Volume : VI, Issue : VII, July - 2016

FRAUD: A PROBLEM TROUBLING INSURANCE INDUSTRY

Suryakant P. Parwat, Aslesha Parwat Mukadam, Dr. Pramod Deo

Abstract :

Health insurance industry is growing and being chanted about like the new mantra, but, still India is facing a huge loss in this sector because of the everyday increasing fraud claims. There is a growing concern among the industry about the increasing incidences of abuse and frauds because they continue to be a major issue for insurers, insurance consumers and regulators. Existence of fraudulent claims, drive up the cost of insurers and inflate premium rates for policyholders due to wide range of illegal practices and acts. There has been a noticeable increase in the number of fraud cases since couple of years which stresses the need of comprehensive risk management strategies that involve fraud risk assessment and fraud prevention. The purpose of this study is to understand and analyze various types of insurance frauds, reasons behind them, triggers to identify them. The paper begins with definition of fraud and abuse, different parties involved in various types of health insurance fraud, triggers that represent possible presence and the actions that could be considered at various levels. Paper also focuses on the possible do’s and don’ts for the insured and the insurers.