How to fake covid and rake in the moolah

When the pandemic was raging and the city was scrambling to hold on to life, a few private hospitals, doctors and citizens were thinking…

Close to April 2021, the second wave of covid-19 peaked, so was the case in 2020 during the first wave. Far away from the battles between life and death, somewhere in Bengaluru, at a private hospital ward, were some individuals in the pink of their health, occupying beds that many outside were dying without.

So, what exactly were these healthy people doing at private hospitals? The answer to this, as BM found out, is beyond belief.

During the first and second waves of the pandemic, a few private hospitals in the city were scamming insurance companies by admitting fake patients — aforementioned individuals of course — providing fake covid-positive reports and forging their certificates along with hospital bills to claim the insurance money, giving a part of it to the ‘acting’ patients. BM has in its possession audio clips of the employees and doctors at certain private hospitals who are heard discussing the scam in detail. We are withholding the names of these individuals and hospitals.

In an audio clip, an employee is heard talking about a special ward where fake covid-19 patients are kept. He tells a new staffer at the hospital that it is a ‘known scam’ and nothing new. While calling out a few patients’ names from a list, the staffer says: “These patients were brought in by Dr X* with covid-positive reports but they don’t have covid-19. They are completely normal, but kept in the ICU.” The stunned new employee replies there are no such patients in the ICU. “I know all the patients in the ICU. Who are these people in the list? How come their names are only on paper?” he wonders. Thereafter, another staff member explains the scam to the newly joined person in detail.

The audio clip in question has been submitted to the Bruhat Bengaluru Mahanagara Palike. BBMP chief commissioner Gaurav Gupta said though directly the BBMP would not hold the hospitals concerned accountable, it would make sure that no system is abused. “We acknowledge such instances with great concern. Nobody should be allowed to get away with this. We will initiate action against such hospitals. We cannot take up investigations directly but will get the officials in-charge to look into the matter.” This BM reporter spoke to employees at several mid-sized private hospitals. They helped bring to light the scale of the massive insurance fraud being perpetuated in private hospitals during the coronavirus pandemic.

“One of the doctors brings in ‘patients’ with covid-positive reports. He would keep them in a separate ward where no other covid patients are present. None of the staff are allowed to visit. The ‘patient’ will be completely normal. He/she will be admitted for 15 days. Their daily updates would not be maintained by any of us. Thereafter, the doctor who got them admitted forges all the documents and creates a treatment summary stating he/she was in the ICU with low oxygen saturation levels. Often, the ‘patients’ concerned would have a minimum of Rs 8-10 lakh health insurance claim. As the insurance companies provide full coverage for covid-19, the hospital claims all the money, without spending a penny. Both the hospital and the person will divide the money accordingly,” said Praveen*, staff at a private hospital.

Priyanka*, an ex-receptionist at another private hospital said that she had joined the hospital last year and after witnessing the scale of the fraud, she decided to quit and never return to work. “Last year too there were patients who seemed asymptomatic but were still admitted in the hospital for 15-20 days. There were no records of them with me. I used to monitor all the patients at the hospital. I would get daily treatment data which was not given for those who were kept in the second floor.

We acknowledge such instances with great concern. Nobody should be allowed to get away with this sort of malpractice. We will initiate action against such hospitals. We cannot take up investigations directly but will get officials in charge to look into the matter

— Gaurav Gupta, Chief Commissioner, BBMP

During the discharging process, doctors would hand over a treatment summary to me stating the individuals concerned were in the ICU. The ward did not have any such facility and it looked more like a general ward. None of the nurses attended to these patients. All the documents would get processed through the insurance executive in the hospital and we did not get any data of such patients.”

A senior BBMP official, meanwhile, added that a few weeks ago, the civic body had conducted a meeting with all the private hospitals asking them to maintain transparency and inform the BBMP about the admissions and discharges at their facilities.

A staff at a private insurance firm told BM that though the companies do not have ample evidence against any private hospital, they do suspect that some hospitals are misusing insurance claims and are cheating the insurance companies. According to him, the firms are conducting thorough checks while processing the insurance money and if irregularities are found, hospitals are blacklisted. (*names changed)

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