False med claims: Insurance firms lose Rs 600 cr

NEW DELHI: The healthcare insurance industry in India faces massive losses on account of disbursals of as much as Rs 600 crore on "false claims" every year, a new study has found.

According to a survey conducted by leading third party administrator for insurance industry MediAssist, the estimated number of false claims in the industry is estimated at around 10-15 per cent of total claims.

The total premium collection for medical insurance firms in the country is about Rs 4,000 crore, while total claims amount to about Rs 4,300 crore in a year - which puts the value of false claims at about Rs 400-600 crore. This means that the healthcare insurance industry is recording an annual loss of around Rs 300 crore.

"In our sample size, we found nearly 25 per cent of claim cases that could be categorized under 'false claims' but as the sample size increases we believe this percentage would settle to 10-15 per cent of total claims which amounts to Rs 400-600 crore," MediAssist CEO B Madhavan said.

The study was conducted with a sample size of 600 cases.

According to MediAssist, eliminating or reducing these false claims could reduce losses and make healthcare insurance viable, while deeper penetration was also needed to make the sector profitable. So far, less than one per cent of the country's population is covered under medical insurance.

"Health insurance is a bleeding sector with very high claim ratio. This study, the first of its kind, is an effort to identify main causes of this high ratio and form a consensus among all stakeholders to work together and minimize malpractices in the system, without affecting genuine claims," Madhavan added.