The General Insurance Council plans to take action in cases of fraudulent health claims raised by hospitals.
Action against hospitals for fraud can range from caution or advisory to suspension of a cashless facility. It can also lead to the exclusion of hospitals from cashless or reimbursement facilities, and legal action may be initiated.
The action would vary depending on the intensity of the fraud, according to Committee Member S Prakash.
"Disciplinary action is expected to be taken on 25 hospitals soon," Prakash, who is also the managing director of Star Health and Allied Insurance Co., said at a press conference in Mumbai on Tuesday.
The council intends to use the technology platform Beema Satark, which enables the sharing of data among insurance companies. Through the platform, insurance companies can get details about vulnerable claims.
The council is looking to enable common empanelment for the hospital and insurance companies. It is also working on the health exchange platform to help digitise and standardise medical insurance claims. It will be monitored by the National Health Authority, the Insurance Regulatory and Development Authority of India, and the council.
The IRDAI is targeting 100% cashless claims from the current 52% for health insurance.
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