General Insurance Council, in its bid to enhance the boldness that medical insurance coverage holders have on the {industry} and to obtain close to 100% medical insurance coverage cowl within the nation, has determined to penalise hospitals for fraud, overcharging and deficiency in companies.
The goal is to enhance companies for insured sufferers in addition to to deliver down prices for the {industry} in order that insurance policies can be found at inexpensive prices.
“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,” stated S Prakash, managing director, Star Health and Allied Insurance Company Ltd., and government committee member, General Insurance Council.
The actions will embody issuing letter of warning, suspension of cashless cost possibility to the hospital, itemizing the hospital as an excluded supplier, and taking authorized motion primarily based on documentary proof.
The council has already recognized some hospitals which is able to quickly face motion. The council has additionally determined to arrange an appellate committee to which the impacted hospitals can strategy 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 stated.
The council has additionally determined to arrange a typical 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 stated.
