Kathmandu. Non-life insurance companies in India have now taken strict action against fraud in health insurance. Companies are now filing police complaints (FIRs) for cheating of small sums of rupees like Rs 20,000.
In the past, non-life insurers were reluctant to register FI because the legal process was lengthy and complicated. Now companies have taken this step to stop the increase in insurance fees of honest insurers.
Fiscal year 2023 in India. On May 24, general and standalone health insurance companies paid claims worth Rs 870 billion. According to insurance companies, about 2 per cent of this claim could have been rs 17 billion fraud. Such fraud claims ultimately increase the health insurance premium.
Now companies are using artificial intelligence and machine learning (AI-ML) based systems. Which identifies questionable claims by looking at the record of old claims. With the help of these systems, companies will be able to detect fraud on time and protect honest customers.
The Insurance Information Bureau (IIB) now shares the triggers of suspicious activities while maintaining data privacy. Apart from this, action is also being taken against those hospitals through the ‘Insurance Vigilance’ portal, which are found to be involved in fraud. These include suspension of cashless facilities, blacklisting and legal action.
The India National Health Claims Exchange (NHCX) is going to be launched. This will facilitate cashless treatment, real-time tracking and quick claim payment to the insured. This will make the process easier for both hospitals and insurance companies.
