Fraudulent Claims in Health Insurance: A Comparative Legal Study of Enforcement Mechanisms

Abstract

Background: Fraudulent claims in health insurance erode trust and inflate costs, demanding robust legal mechanisms for prevention and enforcement.

Objective: This study examines legal frameworks addressing fraudulent health insurance claims in Australia and Kenya, highlighting enforcement challenges and consumer impact.

Methodology: The research employed a comparative analysis of statutory laws, supplemented by interviews with healthcare insurers and legal professionals.

Findings: Australia’s stringent laws ensure effective fraud detection but impose high compliance costs. Kenya struggles with enforcement gaps, exposing the system to widespread fraud. Harmonized international guidelines are suggested.