Fraud in the International Health Insurance Sector

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FRAUD IN THE INTERNATIONAL HEALTH INSURANCE SECTOR

Shihab issa

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Table of Contents

Background        

Research Objectives        

Literature review        

Research Methodology        

Research Design          

Sampling        

Significance of research        

Limitation        

Bibliography           

Background  

  fraud is one  of prominent issues in the insurance industry. (Derrig, 2002) in the 80’s Michael Clarke one of UK leading researchers in area of fraud, have pointed that insurance fraud is becoming a major problems in UK, and requires concentrated attention. (Clarke, 1989)

USA Healthcare expenditure in 2013 was 2.9 trillion dollars = 17.4% of US GDP (cdc.gov, 2013). According to analysis by  R. Busch About $ 25 million are stolen from US healthcare system hourly. (Rebecca S. Busch, 2008)

UK Healthcare expenditure in 2012 was 144.5 billion sterling pounds ( ONS.GOV.UK)

The National Fraud Authority of the UK estimated in 2012 that the UK is losing £73 billion toward fraud. (NFA –Annual Fraud Indicator, March 2012)

The extent of insurance fraud varies between countries. Detected and undetected fraud is estimated to represent up to 10% of all claims expenditure in Europe. (insuranceeurope.eu, 2015) Similar fraud statistics are available for most of the developed countries, and the numbers are staggering, but the above figures are sufficient to  illustrate the scale of fraud and it is impact on the economy.

Coming from an industry background, and based on my experience in the area of fraud in this sector. I feel that organisations on this sector are more venerable to fraud than insurance organization operating in domestic markets. for this reason I have chosen to research this topic.

  The research is aimed to look at the issue of fraud from global perspective, more specifically the area of international healthcare insurance. Some of key questions the study is looking to answer;

How are organization on this sector responding to fraud problem?

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