Kathmandu. A shocking incident in Gurugram, New Delhi, has shaken the healthcare and insurance world. It has been revealed that a hospital is “faking it” for insurance companies instead of treating patients.
The police have busted a scam of cheating insurance companies of crores of rupees through fake doctors, fake patients and fake medical bills. The police have arrested the owner of Galaxy One Hospital, AS Yadav, and his two sons.
The police investigation revealed that Yadav was running not just one hospital but 4 fake hospitals in Farrukhnagar, Dwarka and other places of Gurugram. These hospitals were not only used to treat fake patients, but also as factories to extort money from insurance companies.
According to a report in The Indian Express, Yadav, who claims to be MBBS-MD, also had a fake educational certificate. The gang has been active since 2018 and evidence of fraud of more than Rs 1 crore has been found so far. Police suspect that the amount could be much higher.
Police suspect that this network used more than 500 fake patients to defraud insurance companies of crores of rupees. Now, a Special Investigation Team (SIT) is working to get to the bottom of the matter. The bank accounts of the accused have been frozen and the police are preparing to seize and auction their properties under Section 107 of the new law (BNSS).
How was the scam of crores done?
The scheme of this scam was so cunning that it also failed the strict security standards of insurance companies. This scam was mainly done in 5 phases.
In the past, hospitals were set up in rented buildings that looked real from the outside. In areas like Palam Vihar, large boards and posters advertising surgeries and maternity care were put up in three-storey buildings to avoid suspicion. However, there were no real medical facilities available inside. By recruiting fake patients, members of the network searched for people with valid health insurance policies. They were lured with a small amount of money and their Aadhaar cards and policy documents were taken away. They were then shown to be hospitalized on paper. In reality, they were healthy at home.
Fake Medical File
The hospital staff, including Sapna, Barsha and Gaurav, worked day and night to prepare fake lab reports, fake medicine bills, and doctor’s prescriptions. All the evidence needed to treat a serious illness was presented on paper. During the raids, the police seized more than 60 such files.
Private Researchers{
Insurance companies typically hire private researchers to verify insurance claims. The scam worked closely with investigators. These fake investigators would clean up fake hospital reports and send them to the insurance company claiming that the patient had received the right treatment.
Profit Share{
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The final part of the game began as soon as the insurance company transferred the claim amount to the patient’s account. A small commission was kept for fake patients, and the rest of the money was divided between the fake doctors and his network. –Agency
