ITIC APAC 2025 | Fraud in travel insurance and IPMI

The ITIJ team have been reporting live from ITIC APAC in Hong Kong this week (June 2025) sharing the discussions that took place at the conference. Read all reports

Michael Khan, Mercer Marsh Benefits Leader, Hong Kong and Macau

Khan started by saying that medical trend rates remain persistently high in Asia, at 13%, despite signs of slowdown globally. He added thatmedical trend rates continue to outpace inflation. 

While medical trend rates in Asia were expected to stabilise in 2024 and 2025, he said, they will remain high, with eight out of 10 of the markets projected to exceed 10%, with the Philippines, Indonesia, Malaysia, and Vietnam reporting the highest medical trend rates.

Khan said they asked insurers what the actual drivers of 2024 medical trends were, and increased utilisation due to higher incidence of health conditions (81%) was the number one driver for Asia. In contrast, persistent medical inflation (80%) remains the primary driving factor globally.

He said the ongoing medical inflation (73%), and changes to more expensive or advanced treatments (73%) were the next key contributing factors in Asia. 

Khan said that while the top causes of health plan claims by dollar amount and frequency remained consistent with previous health trends reports, they are seeing interesting developments.

He said catastrophic claims, like cancer, were pushing more employees to the limit of their lifetime claims thresholds. And “groundbreaking treatments for conditions like obesity could have a significant impact on cardiovascular and metabolic health, but are currently very costly”.

Metabolic and cardiovascular risk continues to be the number one risk factor for medical costs, but he was surprised to see that “mental health and psychosocial risk factors were also top risks this year”.  

Khan said that interest in artificial intelligence (AI) is increasing… “but does it have any applications for our industry?”

He said (future) AI benefits helpers would improve the benefits experience. More and more positions will become automated – positions such as customer service agents, data analysts, communications content creators, private investigators, benefit enrolment coaches, and receipt readers. 

Khan finished by talking about Mercer Marsh Benefits’ Health on Demand 2025 survey. This is a global survey of 18,384 employees on their health and wellbeing priorities, concerns and values. 

Dr Cai Glushak, Medical Director and Chief Medical Officer, AXA Partners North America

Dr Glushak started his presentation by saying there are a few main reasons why fraud cases may be increasing in travel:

• More travel means more claims – 18% rise in 2024 (the highest component of which is emergency medical)
• More natural and industry travel interruptions 
• With artificial intelligence (AI), it is easier to commit attempted fraud (including identity theft and document manipulation or fabrication).
   

He went on to talk about the ways in which AI is being used to commit travel fraud identity theft, by creating synthetic identities and using image manipulation. He added that there is a lot of document manipulation (changing dates and/or amounts charged and/or fabricating a medical invoice). 

Dr Glushak then went on to show an example of fraud, and what to look for. He said tech can provide analysis to show that items have been added manually to documents, and that HD zoom can show misalignment of text – another indicator. When it comes to identification, validation tech can be used successfully to help, he said.

Dr Glushak then talked about some unique travel situations, and added that third-party billing can be helped with guarantee of payment (GOP) only for an original hospital invoice.

He said there are some things businesses can do. When it comes to policies and procedures: 

• Require original and detailed invoices
• Require detailed supporting records
• Ask for specific requirements in your GOPs
• Limit benefit for blacklisted providers
• Require advance member contact before seeking care
• Require right to check/request past medical history (PMH) records.

When it comes to tech, he said to check: 

• Bill editing – duplications, coding errors, unbundling
• AI risk scoring
• Machine learning – pattern recognition
• AI – automated fraud detection and trend identification
• Predictive modelling. 

Don’t forget people. And when it comes to people: 

• Train them to a high index of suspicion
• Ensure human validation before claim denial
• Medical personnel will know if “something doesn’t smell right”, with:
  • Inconsistent/unnecessary/non-emergent care
  • Documentation inadequacy 
  • PMH interpretation
  • Not consistent with recognised guidelines.

He concluded by saying that, remember: “Scammers are always one step ahead!”