As one of America’s largest criminal industries, insurance fraud is growing at an increasing and alarming rate. Conservative estimates reflect $20 to $26 billion annually in property and casualty fraud, and $50 to $55 billion annually in health care fraud, with other insurance fraud estimations approaching $100 billion annually. Unfortunately, the establishment of SIUs and red flags in claim files has not kept pace. This is not for a lack of effort from the investigators or claim personnel, but more from the lack of investment in automated tools to assist in the identification and investigation of insurance fraud. Insurance personnel are being overwhelmed with information to manually and subjectively sift through and analyze claim files for the detection of fraudulent activities.
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