‘Insurance fraud is unfair and asocial’

Using social welfare detectives has reduced the number of fraud cases massively over the past decade. If the new law fails to win approval in the November 25, those paying insurance premiums and taxes will once again be the victims, says People’s Party parliamentarian Mauro Tuena.

Until 16 years ago, large parts of the population were convinced that social insurance and welfare beneficiaries do not cheat. When the Swiss People’s Party became the only party daring to claim the opposite, it was heaped with scorn.

The reality, however, looks different. Under the pressure of the People’s Party and later the media, countless fraud cases committed by claimants of social welfare payments came to light. The damages resulting from such scam tactics hovered at around six per cent of the total amount of insurance and social benefits paid. We are talking about billions of Swiss francs.

Use of detectives undisputed

Over the past 12 years, the use of insurance as well as social welfare detectives was undisputed. Even leftwing political parties admitted that surveillance was successful.

The number of fraud cases dropped significantly as suspected cheats became aware of the risk of getting caught. The preventive nature of using insurance and social welfare detectives is obvious.

With its ruling of 18 October 2018, the European Court of Human Rights declared insurance companies’ surveillance activities inadmissible. The decision was based on the lack of an adequate legal basis for such practices in Switzerland.

Social security insurers as well as various social welfare offices stopped all surveillance activities immediately.

As a result, insurance fraud became socially accepted again, there was no reason to fear checks. When it comes to insurance fraud, premium payers are the ones losing out; in case of social welfare, it’s the taxpayers.

Parliament’s well-balanced bill

The Senate’s health commission drew up a draft law to meet the demands of the Strasbourg-based court. It aimed at creating a legal basis for using the well-established system of using insurance detectives as quickly as possible.

In its spring season, the House of Representatives as well as the Senate came out in favour of amending the general part of the social security law. It creates a legal basis to carry out surveillance of insured parties. The new amendments are well-balanced and entrench the practice of the past 12 years.

Now, leftwing groups have challenged this decision to a nationwide referendum.

Social fraudsters are asocial

Insurance fraud is asocial. It significantly pushes up the prices for all honest policyholders, who are the victims of insurance fraud.

In 2017, for example, the Swiss National Accident Insurance Fund (Suva) managed to prevent unjust benefit claims amounting to CHF12.5 million ($12.5 million) without deploying insurance detectives.

In 2016, however, they hired insurance detectives who managed to prevent fraudulent claims amounting to CHF18 million, – CHF5.5 million more than in the previous year.

In 2017, the Swiss Social Insurance Institution Zurich received more than 700 reports on potential fraud, 43% up on 2016. The lack of surveillance opportunities resulted in the number of uncovered cases dropping by around 35%.

A survey conducted among insurance companies came to the same conclusion.

The number of uncovered fraud cases dropped significantly in 2017, compared with the average number of uncovered cases in the last ten years. All surveyed insurance companies agreed that in case of suspected fraud, checking on the insured person in question is essential.

High hurdles

Insurance detectives are the last resort when it comes to uncovering fraud. Before such detectives can be deployed, there are high internal insurance hurdles to overcome.

Ultimately, high costs of such surveillance activities will stop the insurance companies from deploying a detective, unless they have a good reason to suspect fraud.

The aim is to stop asocial insurance fraud. The hundreds of thousands of honest premium payers are the ones losing out as fraud cases drive up their premiums every year.

Honest recipients of insurance benefits, however, have no reason to worry. Their insurance benefits remain untouched. They are not monitored, not even for preventive purposes.

Bearing this in mind, I ask you to approve the legal amendment. Say No to insurance fraud!

The views expressed in this article are solely those of the author, and do not necessarily reflect the views of swissinfo.ch.

Adapted from Germany by Billi Bierling/urs