{"id":2009,"date":"2012-07-12T10:21:52","date_gmt":"2012-07-12T09:21:52","guid":{"rendered":"http:\/\/www.solucominsight.fr\/?p=2009"},"modified":"2014-11-27T15:58:20","modified_gmt":"2014-11-27T14:58:20","slug":"comment-combattre-la-fraude-a-lassurance","status":"publish","type":"post","link":"https:\/\/www.riskinsight-wavestone.com\/en\/2012\/07\/comment-combattre-la-fraude-a-lassurance\/","title":{"rendered":"Comment combattre la fraude \u00e0 l’assurance ?"},"content":{"rendered":"

Il ne se passe pas quelques semaines sans que l\u2019actualit\u00e9 nous le rappelle, un des sports national des Fran\u00e7ais est de frauder, notamment dans l\u2019assurance. Et tout comme en mati\u00e8re de d\u00e9lit routier, seule la peur du Gendarme est r\u00e9ellement efficace. Fran\u00e7ois Bressac, expert assurance chez Alturia Consulting, soci\u00e9t\u00e9 qui s’est r\u00e9cemment rapproch\u00e9e de Solucom, nous explique.<\/p>\n

<\/p>\n

Qu\u2019est-ce que la fraude, qui sont les fraudeurs\u00a0et quels en sont les impacts financiers\u00a0?<\/strong><\/h2>\n

Le concept de fraude est tr\u00e8s difficile \u00e0 d\u00e9finir, la diff\u00e9rence entre abus et fraude \u00e9tant t\u00e9nue. Certains avancent qu\u2019une fraude est associ\u00e9e \u00e0 un \u00ab\u00a0faux\u00a0\u00bb, c’est-\u00e0-dire \u00e0 un document falsifi\u00e9 ou ind\u00fbment poss\u00e9d\u00e9 permettant d\u2019obtenir une prestation non fond\u00e9e. Pour fixer les esprits, disons que l\u2019abus est seulement constat\u00e9 alors que la fraude est r\u00e9prim\u00e9e.<\/p>\n

Il serait tr\u00e8s facile de stigmatiser une cat\u00e9gorie d\u2019acteurs en particulier. La fraude peut \u00eatre r\u00e9alis\u00e9e sur l\u2019ensemble de la cha\u00eene, depuis la d\u00e9claration \u00e0 l\u2019assureur, \u00e0 la prestation (en nature ou en num\u00e9raire) jusqu\u2019\u00a0au moment de sa comptabilisation. Les fraudes les plus d\u00e9licates \u00e0 d\u00e9tecter \u00e9tant celles des professionnels.<\/p>\n

Pour ce qui est de son impact financier,\u00a0par nature, les assureurs comme les compl\u00e9mentaires, ne communiquant pas sur leur taux de fraude mais il serait compris, selon certaines sources entre 2% et 3%. En biens et responsabilit\u00e9s, elle est estim\u00e9e \u00e0 2 milliards d\u2019euros par an et en automobile 30\u00a0000 sinistres mat\u00e9riels par an seraient frauduleux, un sinistre moyen co\u00fbtant un peu plus de 1000 euros\u00a0!<\/p>\n

Quant \u00e0 la CNAM, c\u00f4t\u00e9 sant\u00e9 et pr\u00e9voyance, elle estime \u00e9conomiser 200 millions d\u2019euros chaque ann\u00e9e gr\u00e2ce \u00e0 la lutte contre la fraude\u00a0!<\/p>\n

Quelles sont les tendances en mati\u00e8re de nouvelles fraudes\u00a0? <\/strong><\/h2>\n

En mati\u00e8re d\u2019assurance \u00e0 la personne deux nouvelles tendances apparaissent, l\u2019usurpation d\u2019identit\u00e9 (facilit\u00e9e par l\u2019arriv\u00e9e des nouvelles technologies) et la fraude \u00ab en bande organis\u00e9e \u00bb issue de la coordination de l\u2019action de plusieurs professionnels, accompagn\u00e9es ou non d\u2019une collusion avec l\u2019assur\u00e9.<\/p>\n

Quel que soit la branche d\u2019assurance concern\u00e9e, la lutte n\u2019est efficace que si elle est combin\u00e9e sur 4\u00a0axes (pr\u00e9vention, d\u00e9tection, sensibilisation, r\u00e9action) ce qui suppose de disposer de personnel tr\u00e8s form\u00e9, d\u2019un dispositif de veille technologique et juridique et d\u2019un SI tr\u00e8s performant.<\/p>\n

Quels sont les meilleurs moyens pour lutter contre la fraude\u00a0?<\/strong><\/h2>\n

Pour l\u2019heure on peut identifier des moyens de lutte tr\u00e8s prometteurs.<\/p>\n

La syst\u00e9matisation des r\u00e9seaux de prestataires agr\u00e9\u00e9s d\u2019assurance (r\u00e9parateur auto, opticien ou dentiste agr\u00e9\u00e9, ..) est une bonne r\u00e9ponse car elle permet d\u2019encadrer les pratiques. Les prestataires agr\u00e9\u00e9s, en \u00e9change du respect d\u2019un cadre de pratiques de gestion, sont assur\u00e9s d\u2019un chiffre d\u2019affaires. De plus, ceux-ci sont r\u00e9guli\u00e8rement audit\u00e9s et test\u00e9s par des organismes externes.<\/p>\n

Les initiatives prises r\u00e9cemment par l\u2019ALFA (agence de lutte contre la fraude \u00e0 l\u2019assurance) permettent le partage d\u2019informations entre les diff\u00e9rents acteurs de l\u2019assurance afin de d\u00e9tecter plus facilement la fraude de la part de professionnels.<\/p>\n

Les syst\u00e8mes de datamining<\/em>, outils d\u00e9cisionnels permettant d’\u00e9laborer des scores de potentialit\u00e9 de fraude, d\u00e9di\u00e9s, constituent une r\u00e9ponse tr\u00e8s int\u00e9ressante. Peu encore d\u2019acteurs ont fait ce choix. Mais ceux qui ont tent\u00e9 l\u2019aventure n\u2019ont eu aucune difficult\u00e9 \u00e0 rentabiliser leur projet… On parle de \u00a0plusieurs centaines de milliers d\u2019euros). Malakoff Mederic a par exemple fait ce choix.<\/p>\n

Mais l\u2019avenir passera certainement par un SI de d\u00e9tection commun entre l\u2019ensemble des acteurs de l\u2019assurance, \u00e0 condition, bien entendu, que chacun joue le jeu et mette \u00e0 disposition ses donn\u00e9es.<\/p>\n

Une ombre persistante r\u00e9side cependant dans la faiblesse du cadre l\u00e9gal fran\u00e7ais. Dans des tribunaux encombr\u00e9s, les atteintes aux personnes prennent le pas sur les affaires financi\u00e8res. Certains acteurs peuvent \u00eatre privil\u00e9gi\u00e9s\u00a0: la CNAM par exemple dispose de son propre p\u00f4le sant\u00e9 publique au sein du Parquet. Face \u00e0 cette situation, l\u2019ALFA et les diff\u00e9rents acteurs du march\u00e9 ne m\u00e9nagent pas leurs efforts pour faire aboutir leurs contentieux. Par d\u00e9faut une pr\u00e9vention ing\u00e9nieuse sera le premier et dernier rempart.<\/p>\n

<\/p>\n

 <\/p>\n

Retrouvez tous nos articles sur le secteur de l\u2019assurance sur\u00a0Insurance speaker<\/a>, le blog assurance des consultants Solucom<\/p>\n","protected":false},"excerpt":{"rendered":"

Il ne se passe pas quelques semaines sans que l\u2019actualit\u00e9 nous le rappelle, un des sports national des Fran\u00e7ais est de frauder, notamment dans l\u2019assurance. Et tout comme en mati\u00e8re de d\u00e9lit routier, seule la peur du Gendarme est r\u00e9ellement…<\/p>\n","protected":false},"author":108,"featured_media":6343,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"page-templates\/tmpl-one.php","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[38],"tags":[553,197,552,550,551],"coauthors":[950],"class_list":["post-2009","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assurance","tag-alfa","tag-assurance-2","tag-cnam","tag-fraude","tag-lutte"],"acf":[],"yoast_head":"\nComment combattre la fraude \u00e0 l'assurance ? - RiskInsight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.riskinsight-wavestone.com\/2012\/07\/comment-combattre-la-fraude-a-lassurance\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Comment combattre la fraude \u00e0 l'assurance ? - RiskInsight\" \/>\n<meta property=\"og:description\" content=\"Il ne se passe pas quelques semaines sans que l\u2019actualit\u00e9 nous le rappelle, un des sports national des Fran\u00e7ais est de frauder, notamment dans l\u2019assurance. 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