Insurance fraud is changing as a result of new technologies
Increasingly, cases of insurance fraud are linked to organized crime. Artificial intelligence is also lowering the threshold for fraud and enabling large-scale forgery. Insured persons bear the millions in losses. Suva is also fighting against this.
Insurance fraud takes many forms: Individuals fraudulently claim benefits by providing false information or faking accidents. Companies avoid premiums by moonlighting or systematically abusing bankruptcy. There are also isolated cases of deliberately false billing in the healthcare sector. Increasingly, organized networks are also involved, which deliberately fake claims or systematically evade social insurance premiums and other charges. This leads to distortions of competition at the expense of honest companies that pay statutory levies, while abusive companies circumvent these and thus offer their services at dumping prices. Employees are also affected: Statutory wage and working conditions as well as provisions from collective labor agreements are often disregarded in such cases.
Suva consistently combats insurance abuse and is committed to fair benefits, fair premiums and a strong Swiss workplace and healthcare market.
Combating abuse in 2025: key figures and savings
Attempted insurance fraud? There are always cases that require investigation at Suva too. In the 2025 financial year, Suva examined 2067 reports of suspected fraud in 269,477 cases involving daily allowance or pension payments (2024: 2562). 671 cases were legally closed after suspicion was confirmed.
Suva saved CHF 43.7 million through fraud detection (2024: CHF 31.2 million). Of this, CHF 35.5 million was attributable to prevented unjustified benefit payments by accident victims or medical service providers and CHF 8.2 million to additional premiums collected from insured companies. The average saving per case was 52,906 francs.
Since the introduction of the systematic fight against abuse in 2007, Suva has been able to save a total of CHF 347 million.
Fraud detection: the interplay of human expertise and new technologies
Suva notes that fraud attempts are changing due to artificial intelligence. AI-generated forgeries of documents or images can now be produced more easily and on a larger scale than in the past. «Technological developments such as artificial intelligence lower the entry threshold for fraud,» says Roger Bolt, Head of Combating Insurance Fraud at Suva. «That's why we are making targeted investments in more professional detection and processing tools. The interaction between human expertise and technology is and remains crucial.»
Specialists continue to investigate all suspicious indications - such as discrepancies in files or reports from third parties. In addition, Suva carries out regular company audits and uses insurance investigators as a last resort in cases of justified suspicion. If suspicions are confirmed, benefits that were wrongly paid are reclaimed and the filing of a criminal complaint is examined.
Suva abuse cases in figures
Key figures combating abuse 2025 2024 Number of cases with daily allowances or pension benefits paid out 269 477 263 601 Suspected cases investigated 2067 2562 Closed cases with confirmed suspicion of abuse 671 934 Savings from combating abuse (in CHF million)
Injured persons and medical service providers
Insured companies
43,7
35,5
8,2
31,2
24,9
6,3
Average savings per case (in CHF) 52 906 26 600 Total savings since the introduction of anti-abuse measures in 2007 (in CHF million) 347 303 Number of observations
Source: Suva
This article originally appeared on m-q.ch - https://www.m-q.ch/de/versicherungsbetrug-wandelt-sich-als-folge-neuer-technologien/
