A large-scale health insurance fraud has been exposed in Gorakhpur, where forged documents and fabricated claims drained nearly ₹15 crore from hospital accounts over the past year. Auditors were shocked to find only ₹9,000 remaining when they recently examined the hospital’s books.
Police confirmed that the case is not limited to one hospital. At least four hospital administrators are under questioning, and early evidence points to a wider network involving multiple hospitals and shell entities.
Fake Patients and Rapid Transfers
Investigators said the fraudsters exploited loopholes in the insurance payout system. Funds credited to hospital accounts were quickly moved through several transactions designed to appear genuine. However, there were no patient files or treatment records to support the claims.
“This is the modern face of organised crime, where hospitals and fake insurance claims are pipelines to drain money,” said Professor Triveni Singh, a noted cybercrime expert.
Officials revealed that the fraud targeted several health insurance companies, creating a serious dent in confidence in the sector. Cyber cell officers discovered ghost patients and forged documents linked to dozens of claims. Professor Singh warned that genuine patients will face the fallout:
“Such scams force insurers to tighten compliance. Sadly, this means longer delays for real claimants who already struggle with medical costs.”
Investigation and Wider Impact
Police have seized computers, financial documents, and files from the hospitals involved. They are working with insurance companies to track the flow of funds. While losses of ₹15 crore have been confirmed, investigators believe the total amount siphoned could be even higher.
Authorities are also examining whether the money was channelled through laundering networks, which could widen the scope of the investigation and involve financial regulators.
Experts say the case underlines major weaknesses in India’s healthcare financing system. Without real-time verification processes and stronger digital audits, they warn that such scams will continue to undermine public trust in health insurance.
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