FRAUD IN HEALTH INSURANCE AND WAYS TO AVOIDANCE

Abstract

This article substantiates the importance of investigating such an insurance market problem as fraud in the insurance market. The reasons that encourage fraud in the insurance market are analyzed. The research works of many domestic and foreign scientists are actively investigating the issues of fraud in the field of insurance. Different approaches to the term "insurance fraud" in domestic and foreign practice are defined. The classification of fraudulent actions in the insurance sphere is considered on different grounds: depending on the subjects and stages of preparation and validity of the insurance contract (at the stages of concluding the insurance contract, during the insurance contract and which are carried out by concluding the insurance contract, after the occurrence of the insured event). The motives of insurance fraud are investigated. The probable fraudulent actions in health insurance on the part of the participants of the insurance market are analyzed: insurers, insurers, insurance intermediaries. The fraudulent actions of health care workers were examined separately. Modern ways to avoidance insurance companies with insurance fraud are disclosed, such as explanatory work with assisting companies and clinics, application of additional warnings and conditions in insurance contracts, checking of compliance with the billed prices, careful checking of medical documents before the insurance policy and after the insurance event. The fraudulent actions in health insurance travelling abroad are considered. Overseas experience in combating insurance fraud has been explored, such as Canada, the USA and Germany. Recommendations on mechanisms for ensuring counteraction to insurance fraud in the domestic insurance market have been developed. The results of the study can be used to further explore the health insurance market and other risky types of insurance.