Fraud is a problem affecting all lines of insurance. Due to the level of health care spending in the U.S. and number of third-party payments coming from government programs, health care fraud is a problem for health insurance and certain policy makers. This presentation examines previously developed data analytical methodologies that actuaries and others can use to find and deter health care fraud. Our presentation will identify a number of these methods and develop a tool for actuaries to identify systems for plans they manage. The presentation will also include an opportunity to examine the future of fraud detection and for questions from the audience.
1.50 SOA CPD