By Margo Jenkins (AAA Life) & Rob Strange (Evadata)
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The landscape of insurance fraud is rapidly evolving, and life insurance claims are no exception. With the accelerated development and accessibility of Artificial Intelligence (AI) and generative AI tools, claims examiners are facing sophisticated new threats. Understanding these emerging risks and adopting proactive AI-powered defenses are crucial to safeguarding your company’s financial health and maintaining trust with legitimate policyholders.

“Fraud prevention is easy”, said no person, ever.  An effective fraud prevention strategy is multi-faceted, requiring everyone in an organization to be on board – from the C-Suite to boots on the ground.  For an organization to manage fraud risks and the inherent financial or reputational losses, it needs to know what the risks are, where the risks are, who may exploit any weaknesses, and what the ultimate cost to the organization might be if fraud occurs.  The most effective and comprehensive way to identify such risks is via a fraud risk assessment.  This process seeks to proactively identify and address the organization’s vulnerabilities to internal and external fraud and determine how the organization will respond to these risks.

​Should CPT codes be used for billing or occupation analysis? The answer is both. 
 
In a recent lawsuit, an argument was raised that Current Procedural Terminology (CPT) codes were created and are used for billing purposes, so they should not be used in determining occupation for some reason.  One of the arguments made by an expert in the case was that charges were used, which is not a realistic measurement, as reimbursements and payments received are always less than the charge amount.  The counter argument is that charges are only one metric we use, and we recommend and use Relative Value Units (RVU) and units in all CPT analyzes.     
 
This blog will show why they can be used for both billing and the verification of a physician’s occupation.  

​Insurance fraud, waste and abuse (FWA) pose significant challenges to the integrity and financial stability of the insurance industry. These activities inflate costs, undermine trust, and divert resources away from legitimate claimants, ultimately impacting consumers, insurers and the economy. Combatting FWA requires a comprehensive understanding of its forms, particularly within vital areas such as life, health and disability insurance. This article explores these issues, providing detailed definitions, illustrative examples and real-world case studies to elucidate the nature of FWA and strategies to mitigate it.

Policies may be voided after the contestable period has expired.  There is a common myth that once a policy’s contestable period has expired, there is nothing an insurance company can do to void the policy if fraud is found.  While it is certainly true that the threshold of proof required to void a policy outside the contestable period is higher than rescinding a policy for material misrepresentation, the expiration of the contestable period does not bar action against fraudulent activity.

Synthetic persons, forged documents, bribery, murder, wire fraud and identity takeovers are just some of the fraud crimes besetting the life and health insurance industry.​

​If you want to test your knowledge about VA compensation, ask yourself this question: What does the acronym “VA” mean.
 
If you said Veterans Administration, you are wrong. “VA” refers the Department of Veterans Affairs. This is a tell-tale way to know whether the person you are talking to is knowledgeable on the subject. If they refer to the VA as the Veterans Administration, then I would suggest taking their comments with a grain of salt.

​As professionals working in the insurance industry, we have seen firsthand how outdated or unclear beneficiary designations can create unnecessary delays in claim processing, disputes, legal costs, and hardship for families during an already difficult time. 

When the owner of a tax-deferred annuity passes away, there are several settlement options available to a beneficiary. In this short blog, we’ll go over the basics and explore the most common annuity settlement options.

What is an Annuity?
Interestingly, the concept of annuities goes back in time between AD211 and AD222.  European monasteries raised funds by selling life annuity products and used acclaimed mathematicians from their scientific communities to support the refinements of pricing models.