Ping An to help authorities fight insurance scams with Big Data and AI

Ping An Medical and Healthcare Management Co Ltd (Ping An HealthKonnect), a Shanghai-based platform affiliated to the Ping An Group, said it aims to help China’s authorities to better fight insurance scams with its advanced Big Data and AI technologies.

The announcement came after Hu Jinglin, director of the National Healthcare Security Administration, made a pledge during the ongoing annual two sessions in Beijing that they will severely crack down on fraudulent practices relevant to the country’s health care insurance funds.

Officially launched at the end of May 2018, the National Healthcare Security Administration was created to better manage and control public health expenditure, which is reported to cost around 4 trillion yuan (US$590 billion) a year and will explode quickly if not under proper reins.

This is a huge challenge for the authorities, as China now implements a nearly universal basic health insurance program, which is heavily subsidized by the government.

And the sector has long been plagued with various fraud cases, like fabricating medical services and documents, hospitalizing insurance subscribers after faking diagnoses and providing fake invoices.

Last November, two hospitals in Shenyang, capital of northeast China’s Liaoning Province, were accused of insurance scams, which aroused great attention from regulators.

Lin said while much progress has been made since they tightened supervision, the overall situation remains “grim,” so it will be a top priority for them to carry on the fight against insurance fraud in 2019.

To reach their goals, the administration will partner with more third-party service providers like Ping An HealthKonnect to identify potential fraud risks and gain better control of medical insurance costs by leveraging their advanced technologies in areas of Big Data and artificial intelligence.

Zheng Yi, deputy managing director and chief medical officer of Ping An HealthKonnect, said they are willing to work together with authorities to achieve professional management of the funds.

Zheng added that his firm has offered such services for operators of health care insurance funds in more than 200 cities.

For example, the company entered an agreement with the Xiamen Medical Security Fund Management Center last November, aiming to help the government improve the utilization efficiency of medical insurance funds and control unreasonable expenditure with their smart risk management system.

Founded in 2016, Ping An HealthKonnect operates a managed care platform, which offers health care and business insurance management services, including expense control services, actuarial services and medical resources management services.