Hospital running fake insurance claim racket busted, 3 arrested

A private hospital in Gurugram was raided for allegedly forging medical records to claim ₹1 crore from insurers; three employees were arrested.

A private hospital in New Palam Vihar and a diagnostic centre in Sector 6 were raided on Wednesday for allegedly forging fake medical records to claim money from medical insurance, officials said on Thursday.

The raid was conducted by Gurugram Police and the health department, officials said. (HT)

The raid was conducted by Gurugram Police and the health department, officials said.

Police said three employees of the private hospital identified as Sapna Kumari, Varsha Kumari and Gaurav Kumar, all in their mid-20s, were arrested during the raid.

Abhilaksh Joshi, assistant commissioner of police (ACP) (west Gurugram), said the trio were the main suspects who prepared files of the forged medical records and sent them to insurance firms via couriers to process the claims.

“Medical records of 58 ghost patients were recovered at the hospital during the raid against which ₹1 crore was disbursed from 25 prominent insurance firms,” he said.

“These 58 patients were never treated at the hospital. Each file had bills varying between ₹60,000 to ₹80,000 for various medical conditions,” Joshi said, adding that the total amount might be in crores.

The ACP said the racket was operated by the doctor running the hospital, insurance firm officials, pathology centres and agents responsible for bringing details of fake patients.

“The doctor, suspected of holding a fake degree, received the majority of the claim amount and is presently on the run,” he said.

Investigators said that based on documents recovered from the hospital, another team raided a diagnostic centre in Dayanand Colony in Sector 6 that was preparing forged blood-test reports in the names of fake patients.

Police said details of men from Haryana, Rajasthan, Delhi and Uttar Pradesh were used to create the patients’ records at the hospital.

Police said the hospital and the clinic are sealed.

Investigators said the chief minister’s flying squad conducted an inquiry at the hospital in May last year based on complaints of insurance fraud.

After detailed inquiry of flying squad officials, a report was received on basis of which an FIR for cheating, forgery and criminal conspiracy was registered against hospital at Bajghera police station on Saturday following which a search warrant was procured and raid was carried out.