Aaargh. Yes if everyone tells the truth. But if everyone told the truth then you woudn’t need incentive architects and there is no waste or fraud. Everyone has a “personal fudge factor” which means that a lot of people cheat by just a little bit. This is way worse than a few people who try to cheat by a lot.
The operations of a health insurance provider might be simple, but the architecture that people don’t see running behind the scenes can be incredibly complex.