A massive health insurance fraud has been unearthed in Gorakhpur, where fabricated claims and forged documents drained nearly ₹15 crore from hospital accounts over the past year. Shockingly, when auditors recently examined the hospital’s books, they found only ₹9,000 remaining.
Police say the case is not confined to a single institution. At least four hospital administrators are under questioning, and early findings suggest a wider network linking multiple hospitals and shell entities.
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Rapid Transfers, Fake Patients
Investigators revealed that fraudsters exploited loopholes in insurance payouts. Money credited to hospital accounts was immediately transferred through layers of transactions designed to appear legitimate. However, no patient files or treatment records backed these claims.
“This is the modern face of organized crime, where hospitals and fake insurance claims are pipelines to drain money,” said Professor Triveni Singh, a noted cybercrime expert.
Blow to Public Trust
Officials say the fraud targeted multiple health insurance companies, shaking confidence in the system. Cyber cell officers discovered forged documents and ghost patients tied to dozens of claims.
Professor Singh warned the impact will fall hardest on genuine patients:
“Such scams force insurers to tighten compliance. Sadly, this means longer delays for real claimants who already struggle with medical costs.”
Expanding the Probe
Police have seized hospital computers, financial records, and files, and are coordinating with insurance providers to track the money trail. While ₹15 crore has been identified so far, investigators believe the total amount siphoned could be even higher.
Authorities are also examining whether the fraudsters routed funds through money laundering networks, raising the stakes for financial watchdogs.
What Lies Ahead
The case highlights the vulnerability of India’s healthcare financing system. Experts say unless hospitals and insurers adopt real-time verification and stronger digital audits, such frauds will continue to erode public trust in health insurance.