Quantifying Anti-Fraud Efforts
One problem with the fight against insurance fraud is that its success is hard to quantify. There is no way to say precisely how much a business has saved when a fraudulent claim is not paid since the business or insurer owed nothing in the first place. Did the business save $80 when it did not pay a fraudulent claim for broken glasses? An adjuster might estimate that by stopping the single $80 fraud, the business has saved $80,000 in claims not made in the future, but executives want evidence. The people who operate insurance companies are interested in making a profit. They want to know what the fraud investigation saved and if the amount saved exceeds the cost to save it.
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