Battling Health Insurance Claims Fraud

July 18, 2023

Insurance companies and providers of health care benefits lose hundreds of millions of dollars yearly due to fraudulent claims for health benefits. Some of these are bogus claims that originate from insured persons, while others are payments for insured services that are not needed but are wrongly prescribed by providers who stand to make illegal profits.

Spotlight

Cooperative of American Physicians, Inc.

The Cooperative of American Physicians, Inc. (CAP), established in 1975, offers superior medical professional liability coverage through the Mutual Protection Trust (MPT). MPT has earned an A+ (Superior) rating from A.M. Best since 2006. In 2013, CAP created the CAPAssurance, a Risk Purchasing Group, allowing hospitals, facilities, and large physician groups access to top‐rated liability coverage and risk management services. CAP now supports more than 12,000 of California’s finest physicians through offices in Los Angeles, San Diego, Orange County, and Walnut Creek. CAP is licensed as a California surplus lines broker (License No. 0B72723). The insurance products provided under the CAPAssurance program are issued by a “non-admitted” or “surplus line” insurer that is not licensed by the State of California.

OTHER WHITEPAPERS

Three pillars of insurance transformation

whitePaper | October 20, 2022

Data and analytics have captivated business in recent years: tech startups, retail chains, big banks, movie studios and mom-and-pop shops are all digging into their numbers to power their companies. For insurers, this discovery is nothing new. Data has always been the core of their work. It’s the bedrock of actuarial tables and risk pools, of underwriting and reinsurance. Data-driven insights have powered the industry for centuries, since the days of Lloyd’s Coffee House and mutual benefit societies

Expecting The Unexpected: Australia’s preparation for financial uncertainty

whitePaper | March 15, 2023

For the seventh consecutive year, NobleOak has commissioned research into Australia’s life insurance industry. The goal? To better understand the forces shaping consumer demand in a rapidly evolving sector. Why? Because we hope our findings can help improve the customer experience and the value that Australians receive from products within the life insurance industry.

Key Features of the The Life Insurance Policy within the Prudential ISA

whitePaper | June 14, 2022

If you invest in a PruFund Fund in the Prudential ISA through the Life Insurance Policy, the assets will be held in trust on your behalf by Link Financial Investments (Nominees) Limited in its capacity as the ISA Plan Manager’s nominee. You don’t hold any direct rights under the Life Insurance Policy.

TRADE CREDIT INSURANCE UNLOCKING GROWTH

whitePaper | January 20, 2020

A lot is changing in today’s global economy. Economic growth in North America appears to be slowing; likewise, there are signs of weakness in regions across the globe. With tariff wars, Brexit and military conflicts, there is uncertainty domestically and across the globe. Making business decisions in this environment can be daunting.

Health Insurance top trends 2021

whitePaper | August 20, 2021

COVID-19 brought sweeping implications for all industries, but nowhere more so than in the health insurance industry. And now, firms continue to face challenges on multiple fronts as they work to meet the expectations of both members and employees. At the peak of disruption, the focus was on ensuring business continuity. These days efficiency initiatives are cropping up as insurers adapt to the new normal.

Insuring the net-zero transition: Evolving thinking and practices

whitePaper | April 14, 2022

Endorsed by the UN Secretary-General and insurance industry CEOs, the Principles for Sustainable Insurance (PSI) serve as a global framework for the insurance industry to address environmental, social and governance (ESG) risks and opportunities and a global initiative to strengthen the insurance industry’s contribution as risk managers, insurers and investors to building resilient, inclusive and sustainable communities and economies on a healthy planet.

Claims, Health Insurance

Battling Health Insurance Claims Fraud