IRDA - Insurance regulator and
Development Authority - wants to be able to detect frauds by getting their
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Insurance had withdrawn its cashless facility in private hospitals due to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 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