2023-07-22
"Shielding from Insurance Frauds - BUPA Beyond Boundaries"
NIVA BUPA HEALTH INSURANCE COMPANY
NIVA BUPA HEALTH INSURANCE COMPANY
To begin with today’s time, we all know the importance of health
insurance and we also known with what health insurance is and as well as there
are so many companies who give health insurance. But we never think that this
company also suffers by loss, frauds, etc. One of the known company “NIVA
BUPA HEALTH INSURANCE COMPANY” at New Delhi came across a fraud of Rs. 61 Lakhs.
PVR Enterprises a fake company took
advantage of poor customers/ patients suffering from chronic illness like Chronic
Kidney Disease, Cancer, or Chronic Liver Disease.
A bogus company at Hyderabad duped Niva Bupa Health Insurance Company
of Rs.61.87lakh by submitting claims in the name of its non-existent employees.
PVR Enterprises managed to mislead the insurance provider of an
estimated Rs. 61,87,533/-.
The Niva Bupa Company came across the fraud when Abdullah, a 38
year old manager which has its office at Masab Tank, filed a
complaint with the Masabtank police on Friday.
The claimant stated that since COVID-19, the company started
receiving online application for instituting insurance policies for poor
customers on behalf of assumed employees in need.
In January 2023, the fraudsters submitted 18 online health insurance
application to the company under the guise of being from PVR Enterprises.
They claimed to be legal business entity seeking health insurance
coverage for their employees under corporate Policy/Group Policies. And as the
time goes the scammers added more assumed employees and communicated with Niva
Bupa using fake email address of PVR Enterprises “hr.pvrenterprises@gmail.com” .As a result, insurance policies were issued to
these individuals, and the fake company started filing claims for medical
expenses on behalf of declared employees.
In a very short period of time, Niva Bupa received reimbursement
request and cashless claim for medical expenses from 23 employees of PVR
Enterprises. This employees are related to chronic diseases so they require daily
treatment. In May 2023, Niva Bupa received a total of 40 claims from PVR
Enterprises employees, and 29 of those were already approved for payment,
totaling Rs. 61,87,533/-.
Uncertainty arises when Niva Bupa decided to withhold 11claims
totaling Rs. 19,31,763/- for further investigation. Niva Bupa visited the
address provided by PVR Enterprises, only to appalling facts.
After visiting the location, The Niva Bupa came across the truth
that there is no such type of company exist. The address belonged to a village
approximately 30-40km away from Chennai. The address was that of a farm
house named Hazrath Nilayam. There was no company existence.
As a result, the investigation started and it was revealed that the
claimants were genuine individuals suffering from health issues and undergoing treatment.
On the other side, the scammers including Vikram Reddy Paduri, Hanumanthu Pabathi,
Rajesh Sharma, and Padmani, along with other unidentified names had collided
to cheat the claimant company for financial gain.
They started a fake company under the name of PVR Enterprises and
took advantage of poor patient who were really in need of claims.
The scammers applied for Master Policy/Corporate Policy in the name
of PVR Enterprises and collected the needful amount from them, assumed for treatment.
As they were posing as the employees of the PVR Enterprises and claimed
insurance from Niva Bupa, resulting in a loss of Rs.61,87,533/- for the
insurance company. The Masabtank police filed a case under sections 420, 467,
468, 471, and 120(B) of the Indian Penal Code (IPC) .The case is
still under investigation.
The allegations of fraud against NIVA BUPA HEALTH INSURANCE COMPANY
have undoubtedly brought about uncertainty and concern within the insurance
community. As the investigation unfolds, it is essential to remember the
principle of "innocent until proven guilty" and allow the appropriate
authorities to determine the truth. Regardless of the outcome, this incident
serves as a stark reminder for all insurance providers to maintain unwavering
integrity and uphold the trust vested in them by their policyholders. For now,
both consumers and the industry await the resolution of this complex situation,
hoping for a fair and just conclusion.
- Team IFA