According to the investigations of the U.S. Government Accountability Office (GAO) healthcare claims constitute the represents a pivotal percentage of health and life insurance companies' costs and affects the companies' pricing strategies and social economic benefits in the long term.
The insurance sector combined with quality SixSigma reports in order to reduce medication errors, reveal high level of complexity and fraudulent nature of many of those claims, thus impacting communities trust in the local healthcare system.
In the last decades the phenomenon has been identified as highest percentage of severely injured and damaged citizens, wrong prescription leading to demises, or false reporting.
The aim of this study is to investigate the frequency and severity of different frauds scenarios and identify relevant factors and circumstances included ethical concerns, of the motivation behind, to prevent fraudulent behaviour enhancing insurance claim processes.