General Insurance Council, in its bid to improve the confidence that health insurance policy holders have on the industry and to achieve near 100% health insurance policy cover in the country, has decided to penalise hospitals for fraud, overcharging and deficiency in services.
The objective is to improve services for insured patients as well as to bring down costs for the industry so that policies are available at affordable costs.
“To mitigate frauds we will have unified approach. This will prevent abuse or leakages that are happening. Action will depend on the intensity of the error. We will identify patterns of error and will have unified approach to mitigate fraud,” said S Prakash, managing director, Star Health and Allied Insurance Company Ltd., and executive committee member, General Insurance Council.
The actions will include issuing letter of caution, suspension of cashless payment option to the hospital, listing the hospital as an excluded provider, and taking legal action based on documentary evidence.
The council has already identified some hospitals which will soon face action. The council has also decided to set up an appellate committee to which the impacted hospitals can approach for recourse.
“This will boost the confidence of policy holders and help grow the base. This can reduce fraud and overcharging. Hospitals have to provide good service at appropriate price. While we will punish dishonesty, we will recognise the hospitals that are honest,” Mr. Prakash said.
The council has also decided to set up a common IT platform for industry-wide empanelment of hospitals. “This will address the trust deficit. The growth of the general insurance industry will help the hospitals to grow. Our objective is to deliver good service to policy holders and to erode negative perceptions so that IRDAI’s vision of having health insurance for all by 2027 is achieved.” he said.
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