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The Insurance Times
Frauds in Health
Insurance
Health Insurance is the fastest growing industry in India. However it is badly
affected by the menace of fake claims. Fake medical insurance claims have
now an organized racket with hospitals, patients (insurance policy holders) and even
the policy handlers from the insurer and intermediaries. In India, statistics are also
alarming. According to the survey conducted two years back by one of the leading
TPA the number of false claims in the industry is estimated at around 10-15 per cent
of total claims.
The report suggests that the Health care industry in India is loosing approximately
Rs 600 crore on "false claims" every year. So to make health insurance viable there
is a need to focus on eliminating or reducing fraudulent claims.
Health insurance fraud is described as an intentional act of deceiving, concealing, or
misrepresenting information that results in health care benefits being paid illegitimately
to an individual or group. 'Abuse' is defined as Provider practices that are inconsistent
364 Guide for Health Insurance
