The General Insurance Council is planning to crack down on fraudulent health claims made by hospitals. Action against hospitals for fraud can range from warning or advisory to suspension of cashless facility. It can also lead to exclusion of hospitals from cashless or reimburses facilities, and legal action can be initiated.
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According to committee member S Prakash, action will be taken considering the level of fraud. “Disciplinary action is expected to be taken against 25 hospitals soon,” Prakash, who is also the managing director of Star Health and Allied Insurance Company, told a press conference in Mumbai on Tuesday.
The council says it intends to use technology platforms that enable data sharing between insurance companies. Through the platform, insurance companies can get details about vulnerable claims. The council is considering making a common panel for hospitals and insurance companies. It is also working on a Health Exchange platform to help digitize and standardize medical insurance claims.
It will be monitored by the National Health Authority, IRDA and the Council. IRDAI aims to make 100% cashless claims for health insurance from the current 52%.