The West Bengal Clinical Establishment Regulatory Commission (WBCERC) has initiated an inquiry into allegations of fraudulent medical insurance claims involving four private hospitals after receiving a complaint from a private insurance company. The complaint alleges several irregularities in the processing of insured patient claims. These include admitting patients despite the absence of a clinical indication for hospitalization, unnecessarily prolonging hospital stays, dividing a single surgical procedure into multiple procedures to increase claim amounts, and tampering with medical records to support insurance claims.
Considering the seriousness of the allegations, the Commission has sought relevant documents from both the complainant and the hospitals to examine the claims in detail before proceeding further. The hospitals named in the complaint include one in Kolkata, two in…
