Health Insurance Frauds and How to Stay Safe

Health insurance is a vital safeguard against unforeseen medical expenses, offering financial stability during challenging times. However, as the demand for health insurance grows, so does the prevalence of fraud in this sector. In 2025, health insurance frauds are becoming increasingly sophisticated, targeting unsuspecting individuals and draining their finances.

Understanding these scams and knowing how to protect yourself is crucial. Platforms like Bajaj Finserv app provide a trusted environment for comparing and selecting health insurance plans from leading insurers, ensuring legitimate coverage options tailored to your needs. 

Let us explore the common types of health insurance frauds, their warning signs, and actionable steps to safeguard your finances and well-being.

What are health insurance frauds?

Health insurance frauds refer to deceptive practices aimed at exploiting individuals or insurers for financial gain. These scams can occur at various levels, including fake policy sales, fraudulent claims, or inflated medical billing.

Fraud in the health insurance sector is widespread and affects both individuals and organisations. For instance, unauthorised agents may sell fake policies, leaving buyers with no actual coverage when they need it. Similarly, healthcare providers might inflate billing amounts, leading to higher claim payouts.

Why it matters: Fraudulent activities not only result in financial losses but can also disrupt legitimate claims processing, leaving genuine policyholders in distress during medical emergencies.

To protect yourself, it is essential to understand the various types of health insurance frauds. Here are the most common ones:

1. Fake policies

Fraudsters often pose as authorised agents to sell counterfeit health insurance policies. Victims realise the fraud only when they attempt to file a claim and discover that their policy is invalid.

2. Inflated billing

Healthcare providers may exaggerate treatment costs or add unnecessary procedures to inflate billing amounts. This results in higher claim payouts, which can indirectly affect premiums for genuine policyholders.

3. Identity theft

Scammers use stolen personal information to file fraudulent health insurance claims. This can lead to financial losses and complications for the actual policyholder when filing legitimate claims.

4. Fraudulent claims

Individuals may fabricate medical conditions or falsify treatment records to claim reimbursement. These actions not only harm insurers but also contribute to higher premiums for all policyholders.

Real-world implications

Imagine purchasing a health insurance policy from an unauthorised agent. You pay the premium, but when a medical emergency arises, you find out the policy does not exist. Such scams can leave you financially vulnerable and unable to access necessary healthcare services. Check plans from leading insurers here 

Spotting red flags early can save you from falling victim to health insurance fraud. Here are some common warning signs:

• Unverified agents: Agents who cannot provide credentials or official documentation.
• Unusually low premiums: Policies with premiums that seem too good to be true may lack essential coverage or be fraudulent.
• Unclear policy terms: Vague or inconsistent terms that do not align with industry standards.
• Requests for personal details: Sharing sensitive information without proper verification can lead to identity theft.

Actionable advice

Always verify the credentials of agents and insurers through trusted platforms like Bajaj Finserv app. Be cautious of unsolicited offers and ensure you understand the policy terms before making any payments.

If you suspect health insurance fraud, taking prompt action is essential. Here is a step-by-step guide to reporting it:

1. Contact your insurer or platform: Reach out to your insurance provider or facilitating platform, such as Bajaj Finserv, to report the issue. Provide detailed information about the suspected fraud.
2. File a complaint with IRDAI: The Insurance Regulatory and Development Authority of India (IRDAI) oversees the insurance sector and addresses fraud complaints. You can file a formal complaint through their official website or helpline.
3. Consult consumer protection bodies: If necessary, seek assistance from consumer protection organisations or legal aid to resolve the issue.

Insurance providers play a crucial role in investigating fraud. They may request documentation, review claims, and collaborate with regulatory authorities to address fraudulent activities. Get instant quotes.

Tips to protect yourself from health insurance frauds

Preventing health insurance fraud requires vigilance and proactive measures. Here are some tips to safeguard yourself:

1. Use trusted platforms

Compare and purchase health insurance plans through reliable platforms like Bajaj Finserv. These platforms provide access to policies from leading insurers, ensuring legitimacy and transparency.

2. Verify insurers

Check the insurer's credentials through IRDAI's official website. Ensure the company is registered and authorised to provide health insurance policies.

3. Read policy terms carefully

Understand the coverage, exclusions, and claim process before purchasing a policy. Avoid policies with vague or inconsistent terms.

4. Secure personal data

Protect your personal information by avoiding sharing sensitive details with unverified agents or platforms.

5. Stay informed

Educate yourself about common frauds and warning signs. Regularly review your policy documents and claims history for discrepancies.

Using tools like BMI calculators can help you assess eligibility and avoid misinformation or overcharging. Additionally, platforms like Bajaj Finserv app  simplify the comparison process, allowing you to choose cost-efficient and reliable policies with ease.