Life and health insurers to use advanced artificial intelligence to reduce benefits fraud

Life and health insurers to use advanced artificial intelligence to reduce benefits fraud

(Toronto, February 14, 2022) – The Canadian Life and Health Insurance Association (CLHIA) is pleased to announce the launch of an industry initiative to pool claims data and use advanced artificial intelligence tools to enhance the detection and investigation of benefits fraud.

Every insurer in Canada has their own internal analytics to detect fraud within their book of business. This new initiative, led by the CLHIA and its technology provider Shift Technology will deploy advanced AI to analyze industry-wide anonymized claim data. By identifying patterns across millions of records, the program is enhancing the effectiveness of benefits fraud investigations across the industry.

We expect that the initiative will expand in scope over the coming years to include even more industry data.

"Fraudsters are taking increasingly sophisticated steps to avoid detection,” said Stephen Frank, CLHIA’s President and CEO. “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,” explained Jeremy Jawish, CEO and co-founder of Shift Technology. “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.”

Insurers paid out nearly $27 billion in supplementary health claims in 2020. Employers and insurers lose what is estimated to be millions of dollars each year 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.