Questions Lead to Answers………yet again

Health Insurance…. Everyone Knows the benefits…

But there are a few who know how to take the benefits out of it…

These people are always on a look out for young people who have the Insurance Benefits extended as part of their employment called Group Health Insurance.. These Angels come to the young office goers and lure them with easy money and holidays .…

What if, one of the employee gets sick and admitted for their treatment at some B or C category hospital which may be away from his work place and even residence. It would seem very normal to any employer…

The Insurance companies would also happily approve these claims for hospitalization as these patients are usually employees of reputed organizations…

And The Insurance Officials would also process such claims without suspecting any foul play because even if the Insurance Investigator would visit the treating hospital, the hospital staff is ?more then willing to extend their support for quick verification of these cases…

So technically such claims are 100% legitimate on the face of it.

Everything was going on as per routine…

All the problems started when during investigation of one such claims, the Insurance Investigator insisted to meet the person who got admitted and treated at the hospital because as per the claim details the patient got discharged from the hospital a few days back.

After repeated requests, the patient met the investigator with some of his friend or relative.

When the Insurance Investigator tried a bit hard to see the patient alone second time, he got threatening from some local people over the phone….

Such incidences started to increase and common names and faces were noticed by the Insurance Investigators while working on the cases of different Insurance Companies.

Who were these people……

Where was all this money going……

Why the Hospitals were so Co-operative in verification of documents of these cases…???

Who was running this show….????

?After going through 100s of such cases in 2018-19, a detailed analysis of bank?accounts, phone numbers, hospitals, common names, organizations and all other details; a strategy was worked out and a team was formed to nab these fraudsters…..

All the cases were discussed in detail with the top officials of state police department, and the quantum of fraud was identified to be running into Millions… the nexus involved over 30 people and various hospitals and pathology centers across states.

After a month long surveillance, the police was able to track one of key suspects who was planning a party at a resort with ?few of his friends. However the prime suspect was still illusive and was away from the radar, probably he was very cautious and careful…

This was a perfect chance, and a team was quickly formed and dispatched for picking up the suspects from a party place. 7 people were arrested along with the key suspect. He took all the regular ones for an all night party… Surprisingly all his regular ones were employees of well known Corporates.

After a long interrogation, the details of the kingpin were divulged. He was called in by his accomplice for an urgent meeting and the infamous Amit Sharma and Amit Tyagi were arrested whose names kept on coming in major health claims across the Insurance Companies…

Now it was our time to understand the Game Plan and what came out was quite intriguing….

We had our answers….

Why the hospitals were happy to share all the information on these cases….

How all the documents related to the injury/ailment were prepared with so much perfection…

How the gang targeted the employees of the companies and used their Insurance benefits.

Now it was the turn of these Hospitals and Doctors to answer the Law Enforcement Agencies…