FICCI Working Paper on Health Insurance Fraud


There is a growing concern among the insurance industry about the increasing incidence of abuse and fraud in health insurance. FICCI sub group on health insurance fraud was set up to deliberate upon the issue and come up with a working paper on health insurance abuse and fraud management for the practitioners within the health insurance industry and to suggest a framework of best practices. This paper is the result of sub-groups efforts and deliberations over a short period of 12 weeks.

The paper begins with definition of fraud and abuse, different parties involved in various types of health insurance fraud, triggers that represent possible presence of abuse and fraud and the actions that could be considered at various levels. The paper also captures the issues concerning inadequate legal provisions and concerning code of conduct for medical practitioners.

Please find the working paper attached herewith