Page 253 - Ebook health insurance IC27

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 Check if employees are involved
 If intermediaries are involved take them to task
 Ban the hospitals/doctors if found guilty

6. Risk control unit
 Form or risk control unit in company to fight fraud

7. Doctor seeding
 Employ investigators to disguise as patient and visit doctors and hospitals in the

network of insurance company
 If the doctors/hospitals are found guilty take suitable action

8. Training and application
 Give proper training to employees and intermediaries
 Give regular updates of possible fraud scenarios so that customers may not think to

do the same.
 Create a fear factor in the service providers as well as customers

9. Welcome calling
 Just after selling the policy the insurance companies would call the customer to

verify whether the information provided by them is correct or not.
 This will help to detect fraudulent policies

10. Plug process gaps quickly
 Once fraud is identified it must be plugged quickly
 If any hospital is found billing excess amount it should be removed from network of

hospitals so that it may not do further frauds

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