IRDA Plans to Develop Systems to Detect Claim Frauds

IRDA – Insurance regulator and Development Authority – wants to be able to detect frauds by getting their information updated. To reduce the amount of insurance money paid out to fraud claims – IRDA intends to build systems at the industry level so claims can be verified before money is paid out.

IRDA has invited different firms and organizations to submit proposals for fraud management in the health sector. They have also asked eligible agencies to submit proposals for under writing claims and fraud detection. They are looking for information, fraud alerts and medical history from a single central data base.

The selected agency would not only assist and alert the health industry and IRDA but also root out fraudulent transactions, over charging unlawful claims and multiple claims. IRDA wants to minimize running costs of examining claims by having a central data bank where individual insurers could have access to both software and hardware solutions to help prevent fraudulence.

By 2010 July – four PSU insurance firms – New India Assurance, United Assurance, National Insurance and Oriental Insurance had withdrawn its cashless facility in private hospitals due to alleged overbilling. They suspected that some of these hospitals charged the patients with health cover – higher rates than the normal rates.

IRDA has begun IIB – Insurance Information Bureau – to collect process and sort out data in a centralized system.

The system is needed so that genuine customers need not face problems and insurers also are able to process claims efficiently when fraud detect systems are in place.

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Source-Medindia