Need advice: Health insurance claim fraud by top hospital
The topmost corporate hospital in my city has claimed an amount of Rs 140000 with the insurer for a common daycare procedure. The estimate given by the hospital to the patient was Rs 15000 but they highly inflated the claim to the insurer. The health insurance company reached out to the patient with email details of claim submitted by the hospital where the reason submitted by the hospital was a different advanced disease that the patient didn't even have. The patient sensing something fishy cancelled his appointment with the hospital just 2 days prior to the procedure date.
He consulted another local doctor who recommended the same procedure. The treatment got completed within Rs 4000 (not in a government hospital if anyone is wondering). Yes! the procedure was that simple & straightforward for which the big corporate hospital initially quoted Rs 15000 to the patient & claimed Rs 140000 to the insurer.
This is an exceptional fraud that we just witnessed. The saddest part is it started with the super-specialist doctor who coaxed the patient to get this simple procedure done from that hospital only even though this hospital is quite far from his house. So they are all in it together!
The patient is 70 years old. So he doesn't want to get into legal hassles. But staying silent & letting it slide just because we got saved seems so wrong.
What steps can we take? Can we raise some official complaints in some online portal? We have all the evidence.