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Case Study: Fraud Investigation for International Insurance Company

We equipped an international insurance company with evidence of a fraudulent health insurance claim against them.

Our client, an international insurance company in South East #Asia, had identified a health insurance claim as potentially fraudulent. They needed support to verify whether documentation purported to have been issued by a hospital in Eastern Europe was authentic and to understand whether the claim being made was accurate.

Tapis Intelligence tasked a specialist local investigator to:

  • Provide advice on legally appropriate ways to collate evidence

  • Make a visit to the local hospital and check available facilities

  • Verify the identities of medical officers mentioned in documents

  • Request copies of medical files to support authentication

Our local investigator immediately advised that some requested checks were in conflict with local law. The investigator suggested appropriate alternative checks and completed these through a series of local visits. Evidence collated revealed inconsistencies between submissions made by the claimant and information held on file at the hospital. Local enquiries also highlighted that the reported approach to treatment was not normal practice at the facility. Equipped with evidence that the claim was fraudulent, the insurance company was able to compile a robust case file to refute the claim.

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