Page 252 - Ebook health insurance IC27

The Insurance Times

Role of human intervention in preventing fraud

1. Creation of fraud database
 Create a database and list the name of policyholders involved in fraud
 No insurer should issue policy to such persons
 The service providers- hospitals/doctors involved should also be named
 Information may be posted on website for information to all so that existing service

providers may fear from indulging in any malpractices
 This database should be shared with all insurers

2. Create consumer awareness
 Make the public aware
 Launch a sustained campaign to make the public aware
 Involve customers to fight fraud

3. Robust whistle blow policy
 Launch policy to nab fraudsters
 This is not an actual policy but only to catch the fraudster
 Penalise the persons caught

4. Effective legislation and judicial action
 Frame legislation
 Strong punishment for guilty
 High publicised convictions

5. Fraud management philosophy and policy
 Zero tolerance of the insurance company towards fraud
 Underwriters and claims manager should have clear message

256 Guide for Health Insurance