Insurance Fraud: Serious Consequences

Insurance fraud is an intentional act of fraud, intended to gain illegal profit.

Insurance fraud cases are increasing in Vietnam - Illustration photo: TTC

Insurance fraud is on the rise

A representative of the Vietnam Insurance Association said that the problem of profiteering in the life insurance sector has been around for many years. However, recently there have been signs of an increase in the number and sophistication in the methods of implementation.

Many model projects have been formed, with high warning value.

The insurance industry has also witnessed many sophisticated cases of fraud, leaving serious consequences for the health and lives of insurance participants.

According to records in the Vietnamese market in recent years, insurance fraud does not stop at the calculations of an individual but also involves the participation of many people, even a whole network, including: customers, insurance agents, medical staff...

Dr. Le Dat Chi - Head of the Finance Department, Ho Chi Minh City University of Economics - commented that many people who participate in insurance with the intention of profiting often do not foresee the serious consequences they will face.

Including: "Damage to one's own health and life. Having to return all the money stolen to the insurance company. Being fined, prosecuted and sentenced to a severe prison sentence. Losing the reputation and honor of the family...", Dr. Le Dat Chi analyzed.

Interdisciplinary cooperation is needed

Life insurance fraud is on the rise in Vietnam - Photo: TTO

According to the Insurance Supervision and Management Department (Ministry of Finance), state management agencies have been implementing solutions and sanctions to handle and limit insurance fraud.

However, Vietnam's national database is not yet synchronized, the population database is not linked to medical data, creating loopholes for insurance fraud. There is no data on the medical examination and treatment history of insured people, the history of health insurance use as well as medical examination and treatment services of medical facilities nationwide.

Representatives of the Vietnam Insurance Association stated that the active support of state management agencies plays a particularly important role in preventing insurance fraud and profiteering. Therefore, the insurance business community hopes that the state will soon complete the construction of a common database of the insurance industry and issue mechanisms and legal bases.

From there, information can be looked up to serve the following purposes: appraisal, contract issuance and settlement of insurance benefits, verification, investigation of signs of fraud, prevention of fraud and profiteering of both health insurance and commercial insurance.

A case of insurance fraud and creating a fake scene of a railway accident has been prosecuted by the investigation agency - Photo: TH.HOANG

At the same time, the insurance company recommends that the Ministry of Health and hospitals tighten the procedures and regulations related to medical examination and treatment. Ensure that medical records record the correct illness, have real patients, and that real patient information matches the personal information on the medical records...

In the coming time, the association and member insurance companies will coordinate more closely and proactively in the work of preventing insurance fraud. Research and implement solutions: create blacklists, warning lists of medical facilities, medical staff, disease groups, areas, types of products that are susceptible to fraud and profiteering, share investigation results, detect methods and tricks of fraud, etc.

Currently, many life insurance companies are investing in building a process to guide appraisers in identifying suspicious cases and documents with signs of forgery. Screening suspicious claim files, thoroughly investigating. Using technology to identify, helping appraisers to handle appropriately...

When reviewing and verifying, businesses need to ensure transparency and fairness, both to prevent and stop insurance fraud and to fully and promptly serve the interests of genuine customers.

Source: https://tuoitre.vn/truc-loi-bao-hiem-hau-qua-nghiem-trong-20241223164516932.htm