Health Insurance FraudIn one of the many interactions with friends who are doctors/health experts, we have heard of so many pushed-under-the-carpet scams. Sad to see, that there is a section of people in the medical/health industry which is all for making the entire fraternity loose its trust/dependability.
There are so many lives that are completely and blindly dependant on this profession. People in rural areas, and semi-urban areas, specially in countries like India, usually illiterate, treat doctors almost next to god.
Here's another piece of news which makes the entire Healthcare Industry go red in their faces.
Thanks to the Insurance TPAs, who indirectly unearth such scams/devils.

Pushpa Narayan | TNN

Chennai: At 25, it was a surgery Meena Kumari least expected. She had complaints of an irregular menstrual cycle last year. A city-based private hospital then diagnosed a small fibroid as the problem and removed her uterus. Covered as she was by the government employees’ health insurance scheme, the hospital sent a Rs 40,000-bill to the insurance company.

Sounds routine, but her surgery has now been termed ‘needless’ by an expert panel of doctors of the insurance company. In what could be an indication of medical ethic violation that may have left several women medically unfit to conceive, more than 30% of the hysterectomies done under the insurance scheme have been termed “unwarranted’’ not just by the doctors employed by the insurance company but also by senior private practitioners.

Records available with the insurance companies show that under the government employees’ health scheme, at least 540 women in the age group of 25-35, more than 100 of them in the 20-30 age group, had their uterus or ovaries removed.  Health Fraud Cartoon
"Many young women need not have undergone the surgery—they just needed medicines to regularise their periods,’’ said V Jagannathan,chairman,Star Health and Allied Insurance, who has been warning hospitals against such practices.
Recently, the insurance company removed two private hospitals in Nagercoil and Kanyakumari for charging extra from beneficiaries of Kalignar health insurance scheme. Parallel audits on other health insurance schemes showed that uterus removal for women below 30 years was very low.
Health secretary V K Subburaj said he had not received any formal complaints. “If a hospital is found to be violating rules, it will be removed from our list and face criminal action,’’ he said. Since the launch of insurance scheme in late 2008, 16,000 women have undergone surgeries for removal of uterus or ovaries.

UNDER THE KNIFE
At least 540 women in the 25-35 age group have had their uterus or ovaries removed
Case sheets of patients show that for fibroids as small as 1.4 cm, uterus and ovaries have been removed
Around 30% of such surgeries have been termed needless by doctors employed by insurance firms
Tamil Nadu health secretary V K Subburaj said the state health department was yet to get any formal complaint
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