On the basis of a whistle blower complaint, the insurance regulator IRDAI , on Tuesday, has suspended the certificate of registration of a Third Party Administrator (TPA) and Delhi based E-Meditek Insurance TPA Ltd without notice, with immediate effect..
The violations observed in the inspection of the IRDAI against the E-Meditek TPA are of such serious nature that it is detrimental to the interests of policy holders and the insurers and allowing E-Meditek to continue their activities as TPA shall have adverse impact on the policyholders and insurers, said IRDAI order.signed by the IRDAI member(Non-lIfe)PJ Joseph.
The company was in operations since 21 Mar,2002. According to its website, where there is no mention of IRDA's punitive action against the compoany as yet, the company has over 7 million registered members and relationship with 24 insurers, 10000+ health providers and host of other partners and international alliances..The Delhi based TPA comapny has over Rs 1000 crore business and is one of top ten TPAs in the country.
Gopal Verma, CEO and founder of E-Meditek Insurance TPA was not available for comments.Verma was a development officer in state owned National Insurnace Company, before setting up E-Meditek Insurance TPA..
Market sources say that the whishle blowers are none other than emplyees of the company. However, the industry obserservers are surprised that the IRDA has suspended the TPA license without giving them a chance to explain.
“IRDA's action against E-Meditek Insurance TPA appears to be very stringent and unprecedented one. Let us see, if it would stand to the scrutiny of higher court of law, if company goes for an appeal against IRDAI's move,'' said sorces in the insurance industry. .
“ From the date of this order E-Meditek TPA shall cease to do the business of TPA, however, it may continue servicing the existing health insurance policies based on the discretion and direction of the respective insurers. No Insurer shall entrust servicing of new policies or servicing of new lives under the existing group schemes / policies to E-Meditek TPA. Further steps are being initiated as per provisions of Insurance Act 1938 and IRDAI (Third Party Administrators – Health Services) Regulations 2016,’’ the IRDAI order said..
The IRDAI had received a whistle blower complaint dated 04.09.2017 against E-Meditek Insurance TPA under the provisions of Whistle Blowers Protection Act, 2011 alleging misconduct, corruption, malpractice, money laundering and financial irregularities committed by the TPA.
Consequently, inspection of E-Meditek TPA was carried out from 13.11.2017 to 17.11.2017.During the course of onsite inspection IRDAI detected grave Irregularities like irregularities in respect of policy / claim servicing, irregularities in respect of accounting practices,other Irregularities.
TPAs function as an intermediary between the insurance provider and the insured. It is a company/agency/organisation holding license from IRDA to process claims – corporate and retail policies in addition to providing cashless facilities as an outsourcing entity of an insurance company.