Data sharing scheme tackles PMI fraud

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The Association of International Medical Insurance Providers (AIMIP) has agreed a deal to help cut fraud throughout the private medical insurance (PMI) sector.

A scheme to share data between PMI and IPMI providers has been created in partnership with the Health Insurance Counter Fraud Group and Experian.

It is hoped the pan industry initiative will both customer and healthcare provider fraud.

Carl Carter, chairman of AIMIP and also managing director of provider IMG Europe, told COVER that fraud was a serious concern to the industry.

"There's a lot of fraud going on and it's not just necessarily customer fraud - a lot of it is provider fraud where the hospitals are trying to keep people in for too long or over-inflating the bill or over treating people," he said.

"Defrauding doesn't just mean deliberately and criminally defraud, but deliberately forgetting to add their pre-excluded conditions on the declaration.

"And some brokers in some parts of the world have been known to cheat with application forms, amend them and then send them back in," he added.

The new scheme is hoping to drastically reduce these practices by highlighting identified fraudsters and alerting the rest of the industry.

"We're looking at sharing the data between providers to pick-up fraud between fraudulent claimants, hospitals, doctors and clinics," Carter said.

"You can target these people so if someone applies under different names to different providers and makes multiple claims we can blacklist them and report them to the police.

"And we can go back to those fraudulent providers and say ‘we know you're doing unscrupulous billing practices we can remove you from our network list', he added.

The project was welcomed by Steve Nelson, sales manager at April Medibroker, but he hopes the whole industry will continue working together on the issue.

"It can certainly be effective and I applaud any efforts to do this but I think it needs everyone buying in," he said.

"Getting together and chatting about it can only be a good thing but it needs the buy in of the entire industry, all the plan providers.

"It's no good half of them or three quarters saying we're going to blacklist that hospital when others will still cover people for treatment in those places - so it needs the buy in of everyone really to be totally effective," he added.

Interglobal has also begun telling its customers when renewing to be aware of the possibility of fraud by healthcare providers and explaining its impact on premiums.

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