Medical Insurance Fraud Detection
Naba Suroor, Tanvi Misra · 2024
The dynamic and ever-changing realm of medical insurance fraud detection in India provides an important avenue for insurance companies and stakeholders to strengthen their endeavours in countering fraudulent activities. This chapter illuminates the immense potential of state-of-the-art technologies, including advanced analytics, artificial intelligence, and predictive modelling, to considerably augment the efficacy of fraud detection. Moreover, it delves into the adoption of digitalisation, automation, and blockchain technology as formidable measures to fortify data integrity and alleviate the impact of deceptive claims. By prioritising fraud detection and prevention efforts, insurance companies and stakeholders can safeguard the interests of policyholders, mitigate financial losses, and uphold the integrity of India’s healthcare insurance sector. Collectively, they can forge a resilient ecosystem that proactively addresses medical insurance fraud, ensuring a sustainable and trustworthy environment for all stakeholders involved.