{"id":987653972,"date":"2021-02-12T03:21:31","date_gmt":"2021-02-12T02:21:31","guid":{"rendered":"https:\/\/p4h.world\/news\/healthcare-fraud-insurers-in-the-age-of-anticipation-with-big-data\/"},"modified":"2023-10-04T14:17:07","modified_gmt":"2023-10-04T13:17:07","slug":"healthcare-fraud-insurers-in-the-age-of-anticipation-with-big-data","status":"publish","type":"news","link":"https:\/\/p4h.world\/en\/news\/healthcare-fraud-insurers-in-the-age-of-anticipation-with-big-data\/","title":{"rendered":"Healthcare fraud: insurers in the age of anticipation with Big Data"},"content":{"rendered":"<p><span><span><span><span><span><span><span><span>According to <strong><br \/>\n  <span><br \/>\n    <span>Gilles Le Vavasseur<\/span><br \/>\n  <\/span><br \/>\n<\/strong><strong><br \/>\n  <span>,<\/span><br \/>\n<\/strong><span><span><span><span><span>&nbsp;Director of Operations at group broker G\u00e9n\u00e9ration, 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 &#8211; now capped at \u20ac100 -, repeated fitting by one optician of all the members of several families&#8230; One insurer even saw a patient have 43 crowns fitted, to finance the fitting of implants.  <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n<p><span><span><span><span><span><span><span><span>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.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n<p><span><span><span><span><span><span><span><span>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.<\/span><\/span><\/span><\/span><\/span>  A number of mutuals are experimenting with this approach, but without dismissing the &#8221;&nbsp;good old&nbsp;&#8221; methods&nbsp;: statistics.<\/span><\/span><\/span><\/p>\n<p><span><span><span>The debate is set out in the article to be read <a href=\"https:\/\/www.argusdelassurance.com\/assurance-de-personnes\/sante\/fraude-a-l-assurance-des-complementaires-sante-mieux-outillees.177699\">here<\/a><\/span><\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>According to Gilles Le Vavasseur , &nbsp;Director of Operations at group broker G\u00e9n\u00e9ration, 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 &#8211; now capped at \u20ac100 -, repeated fitting by one optician of all the members of several&#8230;<\/p>\n","protected":false},"author":1633,"featured_media":987531424,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":""},"categories":[],"tags":[115],"acf":[],"_links":{"self":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news\/987653972"}],"collection":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news"}],"about":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/types\/news"}],"author":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/users\/1633"}],"replies":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/comments?post=987653972"}],"version-history":[{"count":1,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news\/987653972\/revisions"}],"predecessor-version":[{"id":987653973,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news\/987653972\/revisions\/987653973"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/media\/987531424"}],"wp:attachment":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/media?parent=987653972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/categories?post=987653972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/tags?post=987653972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}