A major insurance fraud network involving fake hospitals, bogus doctors and ghost patients has been uncovered in Gurgaon, police said after a raid exposed a scheme designed to cheat insurance companies of around ₹1 crore.
The case surfaced after authorities conducted a raid at Galaxy One Hospital on February 18. During the investigation, police arrested A S Yadav (55), who was running the hospital at New Nihal Colony, along with his 2 sons on February 25. 3 employees were also arrested in connection with the case.
According to Abhilaksh Joshi, ACP (West), investigators discovered that Yadav was operating 4 more fake hospitals in places including Farukhnagar and Dwarka. These hospitals existed mainly on paper and were allegedly used to carry out insurance fraud between 2018 and a 2-year period.
During the raid, police recovered nearly 60 suspected fake insurance claim files linked to around 25 companies from Galaxy One Hospital. Officers said the fraud uncovered so far amounts to at least ₹1 crore.
The case first came to light in May last year when the Chief Minister’s flying squad raided the same hospital. During that operation, a doctor was found using the title “MBBS/MD” without possessing a valid degree. Following this, investigators conducted a year-long probe and submitted a formal complaint on February 14 at Bajghera Police Station, leading to the registration of an FIR.
Explaining the fraud method, ACP Joshi said, “In normal course, medical claims involve 3 parties: the hospital, middlemen, and the insurance companies. These companies do not manually check claims and bills themselves, but have private investigators (PIs) to check necessary records like admission and history.”
Police said the accused set up legitimate-looking hospitals and fabricated patient admissions, lab reports, pharmacy bills and treatment documents to show that patients had received medical care.
Investigators also found that individuals were recruited to pose as patients and provide Aadhaar and other details. Claims were filed in their names, and once insurance money was credited to their accounts, they passed it on after keeping a share.
The racket allegedly involved people posing as private investigators who approved the fake claims. Police said the 3 hospital employees — Sapna, Varsha from Gurgaon and Gaurav from Rajasthan — helped prepare and process the fraudulent claims.
Police believe Yadav was part of a larger network. Investigators estimate that more than 500 people may have acted as fake patients. A Special Investigation Team (SIT) is now tracing the wider network and following the money trail.
Joshi also said the case could become one of the first major cases where police use powers under Section 107 of the BNSS to attach assets and compensate victims.
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