According to
Gilles Le Vavasseur
,
Director of Operations at group broker Génération, the nature of health insurance fraud is fairly standard: forged or doctored prescriptions, misappropriation of the lump sum for lenses to supplement reimbursement of frames – now capped at €100 -, repeated fitting by one optician of all the members of several families… One insurer even saw a patient have 43 crowns fitted, to finance the fitting of implants.
Vigilance is called for at a time when many healthcare professionals are experiencing economic difficulties as a result of containment, and may be tempted to compensate for lost sales.
We can therefore count on the adoption of new tools. The most important development has been the progress made in data analysis methods and sophisticated statistical techniques. A number of mutuals are experimenting with this approach, but without dismissing the ” good old ” methods : statistics.
The debate is set out in the article to be read here
