The scourge of fraud also affects the insurance industry, which recorded 9,916 cases for $67.95 billion in the second half of 2021. facecolda Bogotá, Antioquia, Valle and Atlántico were the countries with the highest number of cases in 18 of the 33 companies that accounted for 75% of the premiums written.
The most affected branch was Soat with 5,622 incidents, followed by occupational hazards with 2,318, health with 541 and automobiles with 533.
In the Soat example, 37% had borrowed policy cases where the insurer attempted to collect protections corresponding to an accident that did not involve the insured vehicle or did not apply procedures to the victim. paid doctors (23%).
Other methods, such as excessive or disproportionate differences in osteosynthesis material fees, are also noted by some healthcare providers. It was determined that the main producers of fraud were service providers with 71% and insurers with 15%.
” fake it is a crime and insurance companies are increasingly using more sophisticated tools such as artificial intelligence to combat and control this scourge. This is just one example of the multiple creativity that the industry is exposed to and therefore it is necessary to evolve in these detection tools and constantly monitor new typologies,” said Miguel Gómez, president of Fasecolda.
In the category of labor risks, for example, when a disability was charged twice, and for an irregular relationship (22%), double charge was mainly detected at 58%. The second is that unauthorized companies try to become members of the social security and pension system.
In health policies, the phenomenon of opportunistic demand occurred in 64%, ie when a person tried to demand additional benefits for what was going on, such as aesthetic procedures, which were not in the interest of another medical procedure.
Source: Lare Publica