False claims, a big worry for health insurers

The high incidence of fraudulent claims is becoming a big concern for the health insurers as it leads to huge losses. About a quarter of the health insurance payout goes towards fraudulent claims, if one goes by the industry version.

It is estimated that health insurance portfolio has crossed Rs 50,000-crore mark in 2012-13, though the data is yet to be officially put out.

“The biggest fear for us is that 25 per cent of claims are turning out to be false,’’ Rajiv Kumar, Chief Actuary, Bharti AXA Life Insurance told Business Line .

“We are trying to figure out how to handle the problem as there is no regulation on preventing a policyholder from making a false claim,’’ he added.

According to Sanjay Datta, Head, Underwriting and Claims, ICICI Lombard General Insurance Company, the problem has to be addressed in a collective manner. “Some of us have already come together and are attempting to work out solutions in consultation with the General Insurance Council,’’ he said.

Another functionary of an insurance major said there was a ‘unholy nexus’ between the hospitals and patients.

“We have found that bills are inflated by the hospitals if a patient has an insurance cover while some patients take treatment even when it is not necessary,’’ he said.

But, the industry does not have a mechanism to stop payments for such claims as the paper work is perfectly done, he added.

Health insurance is growing rapidly. According to IRDA data, Rs 13,092-crore premium was underwritten during 2011-12 registering 14 per cent growth over the previous year.

naga.gunturi@thehindu.co.in

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