FDA unearths fake med insurance claims scam

The said bills had insufficient or wrong manufacturing details and didn’t have the signatures of a registered pharmacist.

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FDA
3 min. read

The Food and Drugs Administration (FDA) filed a complaint with the police against a hospital and a medical store in Mulund for allegedly duping insurance companies on the basis of fake medical bills. The said bills, belonging to patients opting to pay through their insurance, had insufficient or wrong manufacturing details and didn’t have the signatures of a registered pharmacist.

According to the written complaint submitted by the FDA officials to the police last week, the officers were alerted in December about some patients at Sarathi Hospital on MG Road in Mulund West who opted for cashless treatment and did not have bills to show the purchase of their medicines. A subsequent investigation by the department revealed several wrong practices in the billing of patients opting for ‘cashless treatment’.

“On visiting the hospital, we demanded to see all relevant documents, including health records and bills of five patients, mentioned in the complaint made to us. All of them had already been discharged and the documents had been sent to the insurance companies by then,” said the statement.

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It further said that the medicines had not been purchased by the patients’ relatives but directly procured by the hospital from the store which is at least a couple of kilometres away. The collective bill of these five patients stood at Rs 27.56 lakh.

D ue to a lack of the mandated information about manufacturers on the bills, the FDA officials then visited the medical store, Shree Ganesh Medical, from where these medicines were procured. “The owner of the shop, Devisingh Bhati, was unable to provide us the seller’s copy of the bills.

The format of the bills of the medicines sold to the hospital was different from the others found in their records. The bills of these patients looked typed rather than printed on the registered software that all drug stores are supposed to use,” said Sharad Nandekar, drug inspector with the FDA.

The biggest surprise for the officials was that the hospital’s payments were made into a personal account of Bhati rather than that of the shop, added the officer. According to the official, when asked about the bills, Bhati said he had misplaced them and didn’t have physical copies of the bills.

The registered pharmacist of the store had no knowledge of these sales, nor were his signatures present on the bills,” the official said. “We then sent out letters to the manufacturers of the medicines mentioned in the bills asking if they had manufactured drugs with the batch numbers in the hospital’s records. A few of them said they had not manufactured any medicines with those batch numbers,” he said.

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While the hospital had all documentation and the owners may not know much about the goingson, but someone from the hospital may have been involved. Based on their findings, the FDA asked the police to register a complaint against those responsible for the fraud.

A police official from Mulund police said that a case has been registered under the Drugs and Cosmetics Act and relevant sections of Indian Penal Code. “This is a very technical case. We will take statements from all concerned before taking any action,” said the policeman.

When asked about the complaint, Dr Neeraj Khanna said that his hospital was in the dark about the fraudulent bills. “We have been purchasing medicines from this store for a long time. We have made all the payments through checks, not knowing what the store owner was doing at his end.

The hospital is ready to provide all necessary cooperation in the enquiry,” he said, adding that he was confident of the hospital’s name being cleared soon.

Assistant Commissioner (Drugs) DR Gahane said that there may be more such cases, which FDA is trying to crack down on.

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