General Insurance Council to take action against fraudulent hospitals

The action against the hospitals could be - the issuance of a warning letter, suspension of the cashless facility, and even blacklisting the hospital as a service provider

PGurus Newsdesk

April 12, 2023

The action against the hospitals could be - the issuance of a warning letter, suspension of the cashless facility, and even blacklisting the hospital as a service provider

Hospitals to face action against false claims

The General Insurance Council has decided to take on the hospitals that are overcharging the health insurance policyholders and indulging in frauds through a series of actions, said a senior industry official.

The General Insurance Council plans to have a common information technology platform to impanel hospitals, he said. It is said that the Council will seek to use the Insurance Information Bureau’s Rohini portal for this purpose.

Speaking to the media, S Prakash, Managing Director, Star Health and Allied Insurance Company Ltd, and Executive Committee member, General Insurance Council, said the industry/ council would take a unified approach against frauds.

Stating that the industry will identify the pattern and take action, Prakash said “We want to send a strong signal to the hospitals. The action against the hospitals could be – issuance of a warning letter, suspension of the cashless facility, and even exclude (blacklist) the hospital as a service provider except in the case of an emergency.”

The majority of the business of the hospitals in major cities comes from patients holding health insurance policies, he said.

According to Prakash, the Council will also have an appellate mechanism where the affected hospital can make its appeal. He said the top line of the non-life insurers contributes to the bottom line of the hospitals.

Several decades ago, the public sector non-life insurance companies tried to blacklist hospitals that gave false bills and other papers so that the health insurance policyholders could make prefer fraudulent claims. But the insurers scrapped the move soon after.

The non-life insurance industry is also looking at working with the National Health Authority to have a common portal for intimating the case details by the hospitals in case the patient is a health insurance policyholder and prefers cashless settlement of the hospital bills, i.e., the insurance company pays the hospital directly.

[With Inputs from IANS]

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