Pet claims investigation, fully automated
Pet insurance is the fastest-growing P&C niche - and a soft target for vet-bill upcoding, pre-existing condition concealment, treatment-plan inflation, and pet-identity fraud. Hesper AI runs a full investigation on every flagged pet claim in hours.
Common pet insurance fraud schemes
Pet fraud spans individual exaggeration to organized clinic-side billing schemes. Hesper investigates every flagged claim across all four schemes simultaneously.
Vet bill upcoding & duplicate billing
Procedures billed at higher complexity than performed, duplicate line items across claim submissions, and phantom services. Hesper AI maps procedure codes against documented treatment notes and detects altered invoice line items at the pixel level.
Pre-existing condition concealment
Owners enroll pets with known conditions and claim for them as if newly diagnosed. Hesper AI pulls and cross-references prior vet records, OSINT signals, and registry data to surface symptoms or treatments that predate policy effective dates.
Treatment-plan inflation
Treatment durations, medication courses, and rehab protocols inflated beyond accepted veterinary standards. Hesper AI benchmarks prescribed treatment against ACVS, ACVIM, and AAHA guidelines for the breed, age, and condition.
Pet identity & breed misrepresentation
Wrong pet covered under the policy, or breed altered at enrollment to dodge premium loading on breed-specific conditions. Hesper AI verifies microchip IDs across enrollment, claim, and clinic records, and validates breed via DNA registry where available.
Manual workflow vs. Hesper
Every phase compresses. The cumulative effect is the difference between a two-week medical-record chase and a same-day decision.
How Hesper AI investigates a pet claim
Every pet claim runs through a structured investigation pipeline. Phases run in parallel where dependencies allow.
Vet invoice and medical record ingest
~5 minVet invoices, SOAP notes, lab reports, and imaging are analyzed across 200+ fraud signals. Every document is checked for line-item alteration, font rendering anomalies, and procedure-code mismatches against the documented treatment narrative.
Pre-existing condition forensic check
~8 minPrior vet history is pulled across clinics and cross-referenced with enrollment disclosures. The system reconstructs the symptom timeline and flags any treatment, diagnosis, or owner-reported issue that predates the policy effective date.
Treatment necessity vs veterinary norms
~9 minPrescribed treatment is benchmarked against breed, age, and condition-specific guidelines from ACVS, ACVIM, and AAHA. Medication courses, anesthesia protocols, and rehab durations are validated against documented standards.
Pet identity and enrollment verification
~6 minMicrochip IDs, photos, and identifying marks are cross-referenced across the enrollment document, claim submission, and clinic records. Breed claims are checked against DNA registry data where available and against the enrollment photo.
Provider pattern analysis and report
~9 minThe treating clinic and any referrals are scored against carrier flagged-provider lists and regional billing-pattern norms. A complete investigation report is generated with evidence packages, timeline, and payment recommendation.
Annual US pet insurance fraud losses
~10% of paid claims, NAPHIA-aligned
Pet insurance market YoY growth
Fastest-growing P&C niche
Hesper AI investigation time per claim
Vs. 1-2 weeks manually
Fraud signals per document analyzed
Pixel-level plus text-level
Go deeper on pet claims fraud
Research, technical deep-dives, and playbooks from the Hesper AI team.
See Hesper investigate your pet claims
We'll run a sample investigation on your real flagged claims and show you the evidence package and report it produces.