CLHIA launches AI-powered solution to fight benefits fraud

CLHIA launches AI-powered solution to fight benefits fraud | Insurance Business Canada

CLHIA launches AI-powered solution to fight benefits fraud

The Canadian Life and Health Insurance Association (CLHIA) is launching a new anti-fraud initiative to enhance the benefits fraud detection and investigation capabilities of the industry.

The association has teamed up with the technology provider Shift Technology to create an advanced AI to analyze industry-wide anonymized claim data. By identifying patterns across millions of records, it is hoped that the program will grow the effectiveness of benefits fraud investigations throughout Canada.

CLHIA’s automated fraud detection initiative is meant to complement the internal analytics each insurer in Canada uses, a release said. The association also said it expects the initiative to expand in scope over the coming years to include more industry data.

"Fraudsters are taking increasingly sophisticated steps to avoid detection," said CLHIA president and CEO Stephen Frank. "This technology will give insurers the edge they need to identify patterns and connect the dots across a huge pool of claims data over time, leading to more investigations and prosecutions."

"The capability for individual insurers to identify potential fraud has already proven incredibly beneficial," added Shift Technology co-founder and CEO Jeremy Jawish. "Through the work Shift Technology is doing with the CLHIA, we are expanding that benefit across all member organizations, and providing a valuable fraud fighting solution to the industry at large."

According to CLHIA, insurers paid out nearly $27 billion in supplementary health claims in 2020. The association also noted that both employers and insurers have lost millions of dollars each year due to fraudulent group health benefits claims.

“The costs of fraud are felt by insurers, employers and employees and put the sustainability of group benefits plans at risk,” the association said.