Prasun Sikdar, MD&CEO, ManipalCigna Health Insurance
The process has been initiated on 18th January by the IIB
“Insurance Satark comes as a boon for the health insurance industry, as it helps us in detecting fraudulent claims. It is only for the health insurance industry. Through this, fraud analytics will be set up at industry level. It will create awareness across the industry for the bad risk portfolios/cohorts and can help companies avoid them. This in turn can eventually help in reducing the premiums, said Prasun Sikdar, MD&CEO, Manipal Cigna Health Insurance said
Mumbai/Hyderabad:
Even as the health insurance business has emerged as the largest portfolio in the Indian general insurance industry, Hyderabad based Insurance Information Bureau is setting up a technological platform ’Bima Satark’ to detect fraudulent claims in the industry.
The process has been initiated on 18th January by the IIB and such a move is the first step for creating fraud analytics platform for the Indian general insurance industry.
“Insurance Satark comes as a boon for the health insurance industry, as it helps us in detecting fraudulent claims. It is only for the health insurance industry. Through this, fraud analytics will be set up at industry level. It will create awareness across the industry for the bad risk portfolios/cohorts and can help companies avoid them. This in turn can eventually help in reducing the premiums, said Prasun Sikdar, MD&CEO, ManipalCigna Health Insurance .
Bima Satark will help the health insurers to exchange information among the general and stand alone health insurance on fraudlent deals which cause a lot of losses for them.
According to Bajaj Allianz General Insurance, claim fraud is the most common health insurance fraud that is committed. Any illegal claim that leads to getting an undue financial gain to the policyholder is an insurance claim fraud.
Following are some of the scenarios that are considered to be health insurance claim frauds:
-Submission of fraud/duplicate medical bills
-Overstating the expenses incurred for health care services
-False accidental injury claim
-Filing a claim for a treatment which has not been received
-Forging the medical documents (like changing the name, date etc.)
The industry will also soon have a Health Claims Exchange (HCX), that will transform the way health insurance claims are processed as the digital platform will reduce cost and waiting time for processing a claim.
Irdai and National Health Authority (NHA) will develop a National Health Claims Exchange as a digital platform to settle health claims..