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Medical Insurance Fraud in India

By Bajaj Markets - Aug 13,2020
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Types of Health Insurance Frauds in India

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Health insurance policies have long been renowned as the best investment that people can make in order to avoid paying huge fees at the time of medical emergencies. 

Medical services have huge costs associated with them including those associated with hospitalisation, treatment procedures, medicines and even doctor costs. To avoid these costs running into huge amounts, a health insurance policy is useful as it attempts to reduce these personal expenses. 

With more and more people realizing the appeal of health insurance policies, there is a huge amount of demand for it. The only downside to the rising popularity of health insurance policies is the increasing amount of medical insurance fraud that it has resulted in as well. While not all frauds are carried out by the policyholder intentionally, they do negatively impact both the policyholder and the insurer. 

There are several types of health insurance frauds. Read on below to learn more about them.

Types of Health Insurance Frauds

  • Claim Fraud:

The most common type of health insurance fraud, claim fraud occurs when the policyholder earns a financial advantage in an undue manner. This can happen when the policyholder submits fraudulent medical bills, or overstates the expenses incurred while availing medical services. Several policyholders may also commit health insurance fraud by forging medical bills.

  • Application Fraud:

Application fraud may occur if the policyholder does not divulge details that are expected to be mandatorily covered in the application form. This could include personal details of the policyholder and members of the family, or the applicant may hide details of pre-existing illnesses or lifestyle choices that may result in an increase in premiums.

  • Eligibility Fraud:

Eligibility fraud occurs when a policyholder submits a claim for a disease or medical treatment bills for a condition that is not covered under the policy.

Medical insurance fraud, in many cases, may occur unknown to the policyholder. However, it may result in several unpleasant situations.

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Outcome of Committing Medical Insurance Fraud

Whether you have willingly or unknowingly committed health insurance fraud, you might actually end up facing legal trouble. There are several consequences you could face for committing medical insurance fraud in India. Read on to learn more about what these could be.

  1. You could lose the benefits of your policy entirely.
  2. Your claims would be rejected in case they are found to be fraudulent.
  3. You might end up bearing a heavy financial burden for your medical treatment.
  4. If your policy is cancelled, you could lose the opportunity to have yourself treated in the best possible manner at network hospitals.
  5. Renewal of an existing policy or attaining a new standard policy may prove difficult. 


Medical insurance fraud is a serious offense in India, and may result in the above mentioned situations. In order to ensure that you do not commit fraud unknowingly, ensure that you are reading the fine print of your policy documents carefully and revealing all the information required by the insurer.

To avail the best health insurance plans, go to Finserv MARKETS where your health insurance benefits are clearly mentioned by the insurer. For only Rs. 198 per month, you can avail a policy with no capping on room rent, in-house claim settlement, and coverage for pre and post hospitalization expenses too.

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Bajaj Finserv Direct Limited ("BFDL") is primarily engaged in distribution of financial products and services through its digital platform (“Bajaj Finserv MARKETS”) and inter alia renders services of customer acquisition, providing preliminary credit support activities, fulfilment services and post-acquisition customer services to Banks, NBFCs, HFCs. BFDL is also a registered Corporate Agent (Composite) under valid IRDAI registration number: CA0551 valid till 10-Apr-2024 for solicitation and servicing of Insurance Products. Registered Office: Bajaj Auto Limited Complex, Mumbai – Pune Road, Akurdi, Pune – 411 035 CIN: U65923PN2014PLC150522