Insights into Health Insurance Fraud Management – Health Insurance Fraud: An Overview

The insurance industry landscape is rapidly changing and with it fraudsters are perfecting newer modus operandi. This has been experienced in the wake of the disruption caused by the Covid-19 pandemic. Understanding what drives fraud as well as the fraudster helps insurers take prudent steps not only to prevent but also to contain fraud and abuse thus ensuring loss containment.

Recommended for

  • Health Underwriters
  • Claims personnel in Health Insurance industry

About the trainer:

Dr C H Asrani DNB (Family Medicine); PGD Medicolegal Systems Adv. Dip in Forensic Medicine & Toxicology CEO, Founder – INCHES’ group of companies

A renowned expert in this area, Dr Asrani pioneered medical audit in insurance in India. With over 300 presentations in insurance risk management, Dr Asrani has been conducting training across Dubai, Bangkok, Kuala Lumpur and Singapore. He also has the distinction of being associated with the National Health Authority (Ayushman Bharat scheme), consulting with The World Bank and being a panelist on various talks on monitoring, audit, and fraud surveillance in the Insurance industry.

He is also one of the first medico entrepreneur to devise cloud-based fraud prevention solutions for insurance companies in India (www.inches-insuretech.com). He is now on an expansion drive to extend his company’s service innovative solutions internationally.

The solutions include medical insights for underwriting, rational claim adjudication, medical processes architecture, clinical audit of claims & underwriter or claim assessor trainings. Dr Asrani’s group of companies have also developed Intelli-Claims, a proprietary tool for medical adjudication of claims using standard treatment guidelines and rule-based analytics.

in collaboration with

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Course Outline
Learning Outline
General overview of Health Insurance industry and why the insurance sector is amenable to fraud?
  • Challenges in combating Health Insurance Fraud for its effective management.
  • Course of a disease
  • Insurance Fraud - Hospital perspective / Medical service provider fraud
  • Deciphering hospital papers
  • Acute ailments and their rational management
  • Conditions requiring emergency hospitalisation
  • OPD vs Day care vs IPD treatment
  • Effective and Rational Claims Management as Key Profit Driver

Contact Info

The Malaysian Insurance Institute 197701004772 (35445-H),
Level 6, Bangunan AICB,
No. 10 Jalan Dato’ Onn,
50480 Kuala Lumpur, Malaysia 

Tel : +603 2712 8882

Email : customercare@mii.org.my

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