01
A signal is a lead, not a finding
Rules, models, statistics and network analysis can surface activity worth examining. What comes out is a reason to look closer, not a fraud verdict.
Governance
Governance principles for Sequrin investigations
A signal is a lead, not a finding. Sequrin can surface and organise activity for investigation, while evidence is assessed by authorised people and consequential decisions remain with the medical scheme's accountable processes. Access, casework and significant administrative actions should also be reviewable after the event.
02
Access follows the job
Being able to sign in should not mean being able to see every investigation or perform every privileged action. Roles and organisation boundaries matter.
03
The important stuff leaves a trail
Investigation history, evidence, access decisions and significant administrative actions should be reviewable later, not just remembered.
04
The judgement calls stay human
Evidence, context and the organisation's own accountable process are what produce a conclusion and any consequential decision.
Sequrin can help your team
- Surface unusual activity for review
- See patterns and relationships more clearly
- Keep evidence and case context together
- Make important activity easier to review later
What stays outside detection
- Deciding that someone committed fraud or misconduct
- Rejecting, delaying or withholding a claim
- Imposing a sanction or contractual consequence
- Publishing a cross-organisation warning on its own
Why the separation matters
Detection gives you a reason to look closer. It doesn't give you permission to punish.
An investigator can gather evidence, build context and reach a conclusion through the organisation's own process. That does not automatically give them authority to take every downstream action or publish something beyond the organisation.
The same principle applies to the longer-term Secure Integrity Network idea: collaboration across organisations would need more rules and more accountability than an internal investigation, not less.
Evaluation planning
Discuss governance requirements for an evaluation.
We can map roles, access boundaries, evidence handling and decision ownership against the way your organisation already works.