Several incidents of health insurance fraud have been reported in India, where hospitals and insurance companies were found to engage in fraudulent practices to cheat patients or policyholders. These incidents not only cause financial harm but also bring down the trust of the public in the healthcare system.
Apollo Hospitals, Chennai, Tamil Nadu (2019):
The Tamil Nadu government initiated an inquiry into Apollo Hospitals in Chennai in 2019 after a liver transplant patient was allegedly overcharged. The hospital was accused of inflating medication costs and performing unnecessary procedures, resulting in a billing discrepancy of Rs. 8 lakh ($10,500 USD). The state government demanded that the hospital reimburse the surplus amount to the patient. The inquiry found the hospital management guilty of violating the Tamil Nadu Private Clinical Establishments Act and the Transplantation of Human Organs Act.
Fortis Hospitals, Gurugram, Haryana (2018):
In 2018, the National Pharmaceutical Pricing Authority (NPPA) discovered that Fortis Hospitals in Gurugram, Haryana, had overcharged a patient Rs. 1.2 crore ($160,000 USD) for a 15-day treatment. The hospital was accused of inflating medication and service costs, resulting in an enormous fraud. The NPPA directed the hospital to reimburse the surplus amount to the patient and imposed a penalty of Rs. 503 crore ($68 million USD) on the hospital. The case resulted in increased scrutiny of hospital billing practices in India.
Medanta Hospital, Gurugram, Haryana (2016):
The Haryana health department found in 2016 that Medanta Hospital in Gurugram, Haryana, had overcharged a patient by Rs. 15 lakh ($20,000 USD) for treatment. The hospital was accused of inflating medication and service costs, resulting in a fraud. The health department ordered the hospital to refund the excess amount to the patient and imposed a penalty of Rs. 25,000 ($330 USD) on the hospital.
Max Healthcare, Shalimar Bagh, Delhi (2017):
Max Healthcare in Shalimar Bagh, Delhi, was accused of falsely declaring a newborn baby dead in 2017. The hospital was also accused of overcharging the family for treatment. The incident resulted in public outrage, and the Delhi government temporarily suspended the hospital`s license. The hospital management was held responsible for the fraud, and the case resulted in increased scrutiny of hospital practices in India.
Religare Health Insurance (2019):
The Insurance Regulatory and Development Authority of India (IRDAI) found in 2019 that Religare Health Insurance had engaged in fraudulent practices to deny claims to policyholders. The company was accused of rejecting claims without conducting proper investigations, resulting in a loss of Rs. 15.9 crore ($2.2 million USD) for policyholders. The IRDAI imposed a penalty of Rs. 1 crore ($137,000 USD) on the company and directed it to pay the denied claims to policyholders. The case resulted in increased scrutiny of insurance companies in India and their claim settlement practices.
All these were reported by reputable news papers including The Times of India, The Hindu, and The Economic Times.