Identifying and Prioritizing Insurance Frauds and Violations and the Antecedents Affecting them in the Field of Supplementary Medical Insurance: A Study in Dana Insurance of Sistan and Baluchistan Province

Despite many advances in identifying insurance frauds, the cost caused by these frauds is still increasing for insurance companies. This research seeks to identify and prioritize insurance frauds and violations and the antecedents affecting them in the field of supplementary medical insurance (Dana insurance of Sistan and Baluchistan province). The method of this study is exploratory in the first stage of data collection and survey in the second stage of data collection. The required data and information have been collected first through library studies and interviews, and then through questionnaires appropriate to each part. The questionnaires were analyzed based on the traditional fuzzy Delphi method. In order to identify the frauds and violations of supplementary medical insurances and related antecedents, 16 experts in this field were identified non-randomly and their opinions were asked. The results were analyzed using SPSS and Excel software. The results of this research showed that in order to prevent insurance frauds and violations, insurance companies can identify the most important causes of violations by carefully validating agents and customers, increase human resources, create points for agents without violations, and determine strict rules in the insurance industry to reduce Fraud and violations in insurance companies can help.