Insurance sector regulator IRDA has decided to appoint research organisations to analyse the pattern of claims to help the regulator put a lid on the insurance fraud in the healthcare sector.
The Insurance Regulatory and Development Authority (IRDA) proposes to enter into a partnership with a firm or an organisation to report on industry-wide trends of fraudulent behaviour affecting the insurance industry.
"The objective of this exercise is to benefit the insurance industry by developing effective reporting on industry-wide fraud trends within healthcare insurance and increasing the difficulty of committing fraud against insurer," IRDA said.
Such an analysis will help insurance companies lower their costs and offer better rates and service for consumers. IRDA has called a meeting of the interested entities on April 30 to inform them about the scope of research to be carried out.
The issue of health insurance claim had become a bone of contention between the PSU insurers and big private hospitals. The insurance companies alleged overcharging by the hospitals.
There are also allegations of fraudulent claims in connivance with the third party administrators (TPAs) to the benefit of the hospitals. The insurers were estimated to be paying 40 per cent more than the premiums collected in claims.
"In order to report on industry-wide trends of fraudulent behaviour affecting the insurance industry, IRDA requests for proposal from reputed organisations for developing effective reporting on industry–wide fraud within healthcare insurance," the IRDA said, while floating the request for proposal (RFP).
The organisation would conduct research based on data collected by the Insurance Information Bureau (IIB), a central repository of insurance industry data.
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