One of industries with the greatest vulnerability is the healthcare sector. Nobody wants to go through the financial and emotional shock of learning that their identity has been stolen or abused in order to obtain healthcare benefits or make prescription purchases.

Fraudsters may even go above and beyond by using another person’s credit card to pay for their medical expenses. Healthcare eKYC solutions can aid in preventing such unpleasant occurrences.

Customers who fall prey to scammers are not the only ones who end themselves in trouble. Insurance companies also sustain large losses. According to a survey by the Insurance Institutes, fraudulent activities cause the healthcare insurance sector to lose extensive amount annually.

What is Fhealth insurance fraud?

The purposeful submission of fraudulent claims to health insurance plans is known as health insurance fraud. This involves lying or misrepresenting, even while the perpetrator is aware that the false claims could result in unapproved benefits for themselves or for a third party.

Going digital is essential for protecting one’s identity and warding off fraudsters. Additionally, it has made registering customers and confirming their identities simpler. People’s awareness of the significance of digitising their health insurance has increased as a result of the rise in medical and healthcare insurance fraud.

eKYC, or digital KYC, reduces the risk of identity theft and the improper use of a person’s information when it comes to sensitive information, particularly in the banking and healthcare sectors.

Going digital streamlines the insurance procedure and guards against fraud in the healthcare industry. Understanding the many types of health insurance fraud is essential to comprehending how online eKYC protects against insurance fraud.

Claim fraud: According to the terms and conditions of an insurance policy, it is claim fraud when a consumer requests health insurance to which they are not legally entitled.

External and internal fraud: External fraud is when a client, a recipient, or a service provider defrauds the insurance provider. Internal fraud, on the other hand, refers to deception carried out by a firm or one of its representatives against a consumer.

Eligibility fraud: Eligibility fraud includes providing false information, such as job duration, to get a status that makes one eligible for further benefits. Any information submitted by the consumer that is in violation of the eligibility requirements may have serious repercussions.

Medical identity theft: One of the frauds that are most common in India is this one. In this instance, anyone can illegally use a policyholder’s name to receive free medical benefits or treatment without that person’s knowledge. Additionally, they could submit claims for insurance that is not theirs, which results in inaccurate data being recorded into the policyholder’s medical records.

Application fraud: In this instance, despite knowing the correct information, a consumer enters false information about their bio, current medical conditions, illnesses, etc. They take this action in order to benefit more.

eKYC for healthcare insurance fraud prevention

KYC (Know Your Client) is currently full. When a client opens an account, the KYC verification entails frequently confirming their identification. eKYC is the internet version of the same process, which is faster and more safe for both customers and insurers.

The criteria for preventing fraud in the healthcare sector are strengthened by eKYC or Digital KYC. It makes use of both human and artificial intelligence to spot fraud attempts and money laundering.

In some circumstances, eKYC uses biometric recognition, which may entail verifying a customer’s fingerprints, or even facial features. More accurate facial recognition is now possible thanks to recent developments in AI technology.

Through the use of live facial recognition technology and document details, online eKYC verifies a consumer to ascertain whether they are using stolen or fraudulent identity credentials for unlawful reasons. The same thing is occasionally done using video KYC, which is more dependable in pandemic situations.

To begin securing your identity and credentials to obtain and secure your health and medical insurances, you can speak with suppliers of eKYC solutions.

eKYC offers various advantages and, in contrast to traditional insurance processes, gets right to the point.