Health insurance frauds: Experts warn of sharp rise in mediclaim scams

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SummaryNeed to reduce the trust deficit between insured and insurer to curb scams, experts have said.

Nine out of ten health insurance frauds in country's insurance sector occur in the mediclaim policy segment and there is a need to adopt measures to reduce the trust deficit between insured and insurer to curb the scams, experts have said.

"In insurance industry, number of grievances received or number of frauds committed is an indicator of growth trend of particular segment. In entire insurance sector, 90 per cent of frauds and grievances come from health policies," said Niraj Kumar, General Manager, Oriental Insurance Company.

He was addressing a seminar on health insurance at Amity University yesterday.

Kumar said if one has to draw two curves for health insurance segment, one indicating growth and second learning curve, it can be observed that the growth curve is ahead of learning curve.

This, he added, implies that industry's main aim is only to sell and market health policies, but there are important takeaways in such shortcomings so that the level of mistrust between insured and insurer can be minimised.

Richard Kipp, Managing Director, consulting firm Milliman said, health insurance in India has increased tremendously over few years but India needs to be cautious in its growth vis-ŕ-vis the US where growth has now become stagnant.

Neeraj Basur, Chief Financial Officer, Max Bupa Insurance Company said that there is lack of trust level among hospitals, third party administrators, insurance companies and customers.

The trust level has to improve and all stakeholders have to understand that it is the customer whose interest is the binding factor, he added.

R R Grover, Advisor, Amity School of Insurance, Banking & Actuarial Sciences, said there is an urgent need to address health insurance requirements of the urban poor.

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