Insurance fraud has become a persistent threat to the sector, illustrating how criminal activity can touch every layer of risk management. In the second half of 2021, the industry disclosed nearly 9,916 fraud cases, totaling about $67.95 billion in potential losses. Regions such as facecolda Bogotá, Antioquia, Valle, and Atlántico registered the highest numbers of cases among 18 of the 33 entities analyzed, which together accounted for three quarters of the premiums written during that period.
Among the different insurance lines, the Soat policy was the most impacted, recording 5,622 fraud incidents. This was followed by claims linked to occupational hazards with 2,318 cases, health-related policies with 541 cases, and automobile coverage with 533 incidents. The concentration of fraud in these categories underscores how vulnerability can manifest across both personal and commercial lines, as well as the importance of robust controls across underwriting and claims processes.
In the Soat sector, a common pattern involved policyholders with borrowed or misused coverage where the insurer faced challenges collecting on protections tied to an accident that did not involve the insured vehicle, or where procedures for the victim were not properly followed. In some cases, healthcare providers received payments for services that did not align with the policy terms, highlighting a spectrum of manipulation in billing and claim submissions.
Additional schemes included inflated or disproportional charges for medical materials, such as osteosynthesis implants, which pointed to supplier manipulation alongside beneficiary or provider collusion. Analysis identified service providers as the primary fraud originators, responsible for about 71% of cases, with insurers contributing roughly 15%. This breakdown helps explain where prevention and detection efforts should focus within the ecosystem.
Industry leaders emphasized that fraud is a crime with evolving methods. Insurers are increasingly deploying advanced analytics, machine learning, and other digital tools to detect irregular patterns, flag suspicious activity, and stop fraud before it disrupts policyholders. This ongoing evolution in technology helps the industry respond to new tactics and maintain trust with the public, clients, and regulators alike.
In the field of labor-related risk policies, the data showed double charging for a disability and irregular relationships as notable fraud vectors. When disability benefits were billed twice, the likelihood of detecting double charging rose to a significant level, and some cases involved unauthorized entities attempting to affiliate with the social security and pension system, aiming to siphon benefits improperly.
The health policy arena revealed another dimension of opportunistic demand. In many instances, claimants sought benefits for procedures or services outside the scope of the original medical need, such as elective cosmetic procedures, which did not serve the primary medical objective. This pattern demonstrated how opportunistic requests can distort the intended purpose of health coverage and create costs that affect the entire risk pool.
Overall, the findings call for a continuous upgrade of detection capabilities, cross-sector collaboration, and a proactive stance on governance and compliance. The industry’s experience in 2021 indicates that confidence in insurance markets depends on transparent reporting, rigorous fraud analytics, and rapid intervention when anomalies appear, all supported by integrated data systems and strong oversight across stakeholders.