SUVA catch insurance fraud after doctor claims to work 24+ hours a day
A new report by the Swiss National Accident Insurance Fund (SUVA) has found that 12,6 million Swiss francs were falsely claimed in health insurance and social security in 2020. Most notable was the case of a doctor who claimed to work more than 24 hours a day, making false claims worth 2,7 million Swiss francs.
2.200 insurance fraud cases in Switzerland referred to SUVA in 2020
SUVA is Switzerland’s public sector insurer, which covers the cost of healthcare for people looking for a job or people who have suffered an accident. As recorded in their annual report, SUVA investigated over 2.200 fraud cases in 2020 and prevented false claims worth a total of 12,6 million Swiss francs from being approved.
According to SUVA, the majority of cases involved what it called “classic insurance fraud,” meaning a person claiming the benefits of a pension or social security programme through false or missing information. They say that the pandemic made their job harder and led to new “increasingly diverse” forms of insurance abuse.
12,7 million Swiss francs recovered by accident insurance fund
Among the traditional cases of insurance fraud, investigators also discovered isolated occasions where workers in Swiss healthcare would charge "fictitious" working hours and services. The example they used was a doctor who claimed that on some occasions they would work over 24 hours a day, perform fake operations, and file charges while they were “demonstrably on vacation.” SUVA calculated that this one person filed 2,7 million Swiss francs worth of fraud.
In summary of the report, Watson noted that consistent fraud “not only harms premium payers but the entire healthcare system,” although it must be stressed that the vast majority of claims are correct and accurate. Since starting anti-fraud operations in 2007, SUVA estimated that over 194 million Swiss francs in unjustified claims have been prevented.