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PETALING JAYA: In just five years, from 2018 to 2022, the Social Security Organisation (Socso) detected 683 cases of fraudulent claims amounting to RM43mil.

In some cases, people even try using a dead persons number to make claims, said Socso chief executive Datuk Seri Dr Mohammed Azman Aziz Mohammed.

Of the 683 cases, 487 are being investigated further; from that, 318 cases or 65.3% totalling RM28.8mil have been repudiated.

With this action, Socso has managed to save about RM86mil in terms of future savings for the organisation, Mohammed Azman revealed to The Star.

Fraudulent claims are a bane to Socso, and protecting its funds from them involves tedious data mining that reveals discrepancies like sharing of addresses, localities and phone numbers by claimants.

The organisations Anti-Fraud System has accumulated millions of data bytes since its inception in 2017.

However, Mohammed Azman said that as they continue to build the system with more data, it is difficult to ascertain the actual amount of losses caused by fraudulent claims.

When asked how detrimental fraudulent claims can be for Socso, Mohammed Azman said that even though the organisation has a reasonable amount of assets, it may not be enough to sustain it and be relevant in the long term.

This is due to its commitment of roughly RM5bil for all benefit payments given out to insured persons (workers covered by Socso) or their dependants, Mohammed Azman explained.

For example, if an insured person earns RM5,000 a month, his or her contribution under the scheme is RM49.50 every month, based on the employees contribution rate of roughly 1% of their monthly salary.

If he is certified as an invalid by the Medical Board due to his illness and fulfils the invalidity claim requirements, he will receive an invalidity pension up to RM3,217 a month for life.

If the worker dies and he has a wife as well as children, Socso will support his family with a survivors pension given to his dependants for life, and to his children until they are 21 years old or married, whichever is earlier.

If the workers wife is 30 years old at the time of his death, that pension would amount to about RM1mil eventually.

This is the kind of long-term liability we have to commit to under Act 4. That is why we need to monitor fraudulent claims closely, he said, referring to the Employees Social Security Act 1969.

Mohammed Azman also said that retrieving payments poses a difficulty due to claims lapsing over time; as such, stopping payments as a first step is the best option in most fraud cases that are detected.

When an invalidity claim comes in, we will process it and bring the claimant before the JD (Medical Board) to determine the claimants invalidity.

If he is certified invalid, Socso will make the payment, but after the benefit payment is made, we will analyse the data again.

In any case of suspected fraud, we will resubmit the case to the board for verification again. If the case is a straightforward one with an admission of guilt, Socso will immediately stop payments, he said.

Mohammed Azman pointed out that the organisation has a zero tolerance policy towards abuse of claims, and the goal is to minimise it as much as possible.

To achieve this, he said Socso has a supervision plan in place and also monitors transactions and carries out surveillance.

Socso has also adopted the Anti-Bribery Management System certification to deter attempts to bribe its officers.

We also use data science and artificial intelligence and establish close cooperation with the police and the Malaysian Anti-Corruption Commission to prevent fraudulent claims and take action against the culprits, he said.

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Socso hit with 683 false claims from years 2018-2022 - The Star Online