Non-life insurers to punish fraudulent hospitals

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

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 will 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 cashless facility and even exclude (blacklist) the hospital as a service provider except in the case of an emergency."

Majority of the business of the hospitals in major cities come 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.

Prakash said the topline of the non-life insurers contribute to the bottomline 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 can make prefer fraudulent claims. But the insurers scrapped the move soon after.

That apart, the General Insurance Council plans to have a common information technology platform to empanel hospitals, he said. It is said that the Council will seek using the Insurance Information Bureau's Rohini portal for this purpose.

In addition, 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.