Case Study: Agis Zorgverzekeringen doubles fraud detection performance with FICO's Insurance Fraud Manager

FICO Insurance Fraud Manager doubles Fraud Detection Performance for Agis

Agis Zorgverzekeringen, one of the five largest health insurers in the Netherlands with about 1.2 million customers and €2.5 billion in annual claims, faced rising pressure after market privatization to reduce losses from undetected provider fraud. Most claims were auto‑processed (only 2–3% reviewed), and Agis’ manual, rules‑based post‑payment investigations were slow, costly and unable to detect new or complex fraud patterns.

Agis ran a proof of concept of FICO Insurance Fraud Manager on 12 months of dental claims (€101M, ~3,200 providers) and the predictive models doubled the number of known fraudulent suppliers found—identifying 106 suspicious dentists and uncovering 12 additional likely fraudsters among the top 30. The trial value was estimated at €1.2M, Agis projects a 250% ROI in year one, and plans a full rollout (with potential industry‑wide savings up to €10M) to improve detection, prioritize investigations and extend to other business units.

Agis Zorgverzekeringen

Erik Van Doorn

Manager, Process Quality and Support