In recent years, with the expansion of insurance coverage, the risk of insurance fraud has gradually emerged, and related crime cases have increased year by year, seriously infringing on the legitimate rights and interests of consumers, affecting the high-quality development of the industry, and damaging the social credit system. In order to severely crack down on illegal and criminal acts in the insurance field and improve the ability to prevent financial risks, the CBIRC and the Ministry of Public Security have strengthened communication and cooperation, improved systems and mechanisms, and jointly carried out special actions against insurance fraud for two consecutive years.
In order to solve the outstanding contradiction that traditional manual screening of fraud leads is difficult to meet the massive growth of insurance policies, and to adapt to the new trend of professionalization and gangization of insurance fraud crimes, since October 2019, the CBIRC and the Ministry of Public Security have carried out big data anti-insurance fraud pilots in Zhejiang, Anhui, Jiangxi, Shandong, Ningbo and Qingdao, innovatively using new technologies such as big data to prevent insurance fraud risks and combat financial crimes, and achieved initial results. In the past year, a total of 545 insurance fraud leads have been transferred to the public security organs in six pilot provinces (cities), and nearly 200 cases have been filed, involving more than 100 million yuan.
Strengthen institutional safeguards and build a law enforcement coordination mechanism that links up and down. The Risk Disposal Bureau of the China Banking and Insurance Regulatory Commission and the Economic Investigation Bureau of the Ministry of Public Security established a “general to general” mechanism, signed the Memorandum of Understanding on Strengthening the Coordination and Cooperation Work Mechanism, negotiated the pilot work plan, and guided and promoted the pilot work. The Zhejiang and Ningbo Banking and Insurance Regulatory Bureaus and the Public Security Department jointly signed the “Minutes of Cooperation in Preventing and Combating Illegal Crimes in the Field of Banking and Insurance”; The Anhui Banking and Insurance Regulatory Bureau and the Public Security Department held a joint meeting on anti-insurance fraud work to clarify the cooperation framework for data sharing; Qingdao Banking and Insurance Regulatory Bureau cooperated with public security economic investigation and traffic police departments to promote road traffic accident video inquiry and other fields; The Shandong and Jiangxi Banking and Insurance Regulatory Bureaus and the public security economic investigation departments have improved mechanisms such as daily case communication and cooperation.
Break through information silos and explore and promote cross-departmental data integration. In view of the problem that it was difficult to identify fraud risks in a timely and accurate manner by relying solely on insurance policy information in the insurance industry or police data of public security organs, the CBIRC guided China Banking and Insurance Information Technology Management Co., Ltd. and some large insurance companies to establish a “green inquiry channel” for public security organs, promote the integration of big data platforms such as insurance claims, traffic accidents, violation handling, public security cloud search, and public security policing, and realize the cross-departmental information and data interaction collision of “public security + insurance”.
Make good use of technology empowerment to accurately prevent and resolve financial risks. The CBIRC in the pilot areas cooperated with the economic investigation department to summarize the characteristics of the crime, set a reasonable dimension, refine the relevant rules, and develop and establish a fraud crime data model for various types of insurance such as automobile insurance, accidental injury insurance, and aviation delay insurance, and carry out cases.Intelligent analysis and judgment of clues further improves the accuracy of combating financial fraud crimes.
In the next step, the CBIRC and the Ministry of Public Security will continue to promote anti-insurance fraud cooperation, study and improve data interaction and sharing methods, jointly build insurance crime data models, and explore the formation of a new model of cross-departmental big data anti-insurance fraud.
(Source: China Banking and Insurance Regulatory Commission)