Preventing fraud and providing services: The Private Healthcare Insurance Sector

The private healthcare insurance sector is rarely the subject of criminological analysis unless seen as corrupt. It is even more unusual that it is the subject of analysis as a victim of fraud. This paper is thus different in that it establishes a picture of international private healthcare insurance sectors approach in preventing fraud and providing healthcare services. We start by explaining why the private health insurance markets exist. This is followed by the methods employed to secure innovative data from the private health insurance sector. The results of the research conducted in collaboration with the International Federation of Health Plans are then presented. A discussion on key aspects of this research is then examined before we lastly, consider a way forward and the development of fraud resilience in the private insurance healthcare market.