Health insurance is supposed to protect you and your family, but scams are on the rise, and the number of health insurance frauds in India is staggering.
Every year, fraudsters steal ₹600–800 crore, leaving honest policyholders to deal with rejected claims, higher premiums, or policies that fail when they need them most.
These scams aren’t just happening in big cities; they’re popping up in small towns too.
Fake bills, rogue agents, and hospital fraud are just a few of the tricks criminals use to target unsuspecting people.
If you already have health insurance—or are thinking of getting one—it’s crucial to know the warning signs.
This guide will walk you through the most common scams, real-life stories from India, and simple steps to protect yourself.
Ready to learn how to spot the red flags before it’s too late? Let’s dive in!
Types of Health Insurance Frauds
Scammers use new tricks every year to cheat honest people out of their health insurance benefits. Here’s what you must watch for:
The Common Frauds
- Claim Fraud: Submitting fake or inflated bills, claiming for treatments you never took, or teaming up with a hospital to get more money from the insurer.
- Fake or Forged Policies: Agents faking paperwork and taking your money, leaving you with no real coverage.
- Hidden Illnesses or Details: Lying about medical history or age to get a cheaper policy—then claims get denied, and you’re left stuck.
- Multiple Claims Scam: Filing the same claim with more than one insurance company to get paid twice.
- Hospital Billing Fraud: Hospitals charging for services you didn’t get, or creating fake admissions and pharmacy bills.
- Digital and Phishing Scams: Fraudsters use emails, calls, or WhatsApp pretending to be insurers or regulators, tricking you into paying for fake policies or giving out your personal info.
Red Flags of Health Insurance Frauds in India
Here are a few signs that help you identify fraud and protect you from facing any kind of financial distress:
- You’re told to pay quickly by cash or UPI to a personal account, not the company.
- Your policy doesn’t show up on the insurer’s website or helpline after you pay.
- You never get an official confirmation from the insurance company—just agent messages.
- Policy documents with errors, missing stamps, or your name spelled wrong.
- Agents asking for PAN/Aadhaar over WhatsApp or SMS.
- Bills with weird charges, or from hospitals and pharmacies you never visited.
If something feels off, stop and check with the company directly—these red flags are warning signs for a reason.
List of Major Health Insurance Fraud Cases in India
Scam stories aren’t just something you read in the papers—they’re happening all over India right now. Here are some of the biggest health insurance fraud cases making headlines:
The Sambhal Multi-State Scam (2025)
A criminal gang in Uttar Pradesh’s Sambhal district used forged death certificates and fake hospital documents to buy health (and life) insurance policies on people who were dying or already dead.
By bribing officials and working with hospitals, they claimed over ₹100 crore in payouts before the police cracked down.
Ayushman Bharat Mega Claims Scam
Fraudsters in Punjab, Haryana, and Himachal Pradesh created fake hospital bills and admissions to claim ₹562.4 crore under the Ayushman Bharat health insurance scheme.
Hospitals, agents, and some government staff worked together—generating thousands of false claims and payouts until authorities started investigating.
Digital Pharmacy Bill Fraud
A Kerala resident used canceled online pharmacy orders to make and submit fake bills for “post-hospitalization” expenses and was able to claim from multiple insurers before being caught.
This scam shows how even digital bills and new tech are being used to trick insurance companies.
Hospital Billing and Admission Frauds
Across big cities, hospitals have been caught inflating bills for unnecessary procedures, billing for fake admissions, or creating false drug receipts.
Sometimes agents and insiders are part of the setup, making it tough for policyholders to spot—until a real need arises and claims get rejected.
How to Spot Health Insurance Fraud?
Don’t get fooled—use this simple checklist to catch fraud before it hurts you:
1. Buy Smart: Only purchase health insurance from registered agents, company branches, or official websites—never from random calls or chat links.
2. Verify Policy Status: As soon as you pay, check your policy on the insurer’s website or customer helpline. If it’s not there, something’s wrong.
3. Read Every Document: Double-check names, policy numbers, and amounts for mistakes. Watch for missing stamps, spelling errors, or strange details.
4. Be Careful with Personal Info: Never share PAN, Aadhaar, or health details on WhatsApp, SMS, or with anyone who won’t prove they are official.
5. Check Every Hospital Bill: If you or a family member is admitted, read every bill, treatment code, and pharmacy receipt. Ask for explanations for any odd or inflated charges.
Look Out for Fake Offers: Don’t trust policy deals from emails, calls, or websites unless you’re sure it’s the real company.
How to Complain Against a Health Insurance Company in India?
If you spot fraud, have an unresolved claim, or think your insurer or agent has cheated you, speak up—fast action is key. Here’s exactly what to do:
1. Contact Your Insurance Company First
Start by lodging a formal complaint directly with your insurer—use their official website, customer care number, or branch office. Attach copies of bills, policy documents, and all proof. Always ask for a complaint number and keep records of calls or emails.
2. File a Cyber Crime Complaint
- Visit the Cyber Crime Portal
- Register and log in
- Select the type of complaint you want to raise
- Draft the details and upload evidence
3. Escalate to IRDAI if Needed
Not getting help or your issue isn’t resolved in 15 days?
- Use the Bima Bharosa System
- Email: complaints@irdai.gov.in
4. Approach the Insurance Ombudsman
For serious or stubborn cases (like big fraud or repeated claim rejection), you can write to your state’s Insurance Ombudsman. Find details at: policyholder.gov.in/ombudsman
5. File a Police Complaint
If you were sold a fake policy, cheated by an agent, or are the victim of forged documents, go to your nearest police station with all your evidence and file an FIR.
6. Keep Track and Follow Up
Don’t drop your case—follow up on your complaint numbers and keep pushing until you get a reply or solution.
Need Help?
Register with us and get quick help in reporting the complaint and in further escalation if required.
Conclusion
Health insurance should bring security, not stress. But with scams growing everywhere, it’s smart to double-check every policy, bill, and offer, no matter how busy you are.
If you even suspect something is off, act fast: complain, report, and tell your family not to ignore the warning signs.
Stay alert, stay informed, and share these tips with your loved ones. The more you know—and the sooner you act—the safer your money, your health, and your peace of mind. Together, we can stop health insurance fraud before it happens!
