2.58 lakhs Mediclaim scam of producing false bills for knee surgery unearthed in Vadodara

Detention of doctor, laboratory employee and husband of mediclaim holder

The insurance company had lodged a complaint at the Panigate police station against a doctor, a laboratory employee and a couple for fabricating a Mediclaim bill of Rs 2.58 lakh for making false bills for knee surgery. Police arrested the doctor, laboratory worker and the husband of the mediclaim holder on charges of fraud in the case, while the woman who filed the mediclaim has not yet arrested.

Living in Ahmedabad Dr. Keurbhai Patel works as an Investigation Officer in Royal Sundaram General Insurance Company. His company deals in issuing general insurance policies. In a complaint lodged at the Panigate police station, he states that Sejalben Bhaveshbhai Kukadia (resides in Kanha Gold Residency, Dabhoi Road, Vadodara) had obtained health insurance from their company. She then prepared treatment papers and handed them over to the company. Sejal took the policy from the company on 27/4/2019, whose term was till 26/4/2020.

Sejalban then submitted the documents to TPA Company on 16/7/2020 and applied for Mediclaim of 2,58,984. When the company became suspicious, their company handed over the investigation to a private investigation agency. During the investigation, it was found that Sejalben presented the bills and laboratory report of Sannandhi Hospital near Parivar Char Rasta on Waghodia Dabhoi Ring Road.

During the investigation, the hospital’s doctor Animesh Solanki said, “Confirming our records, Sejalben did not seek treatment at the hospital and misused the hospital’s documents.” But it was later found out that even though Dr. Animesh Solanki did not treat Sejalben, but helped her in making all the documents related to the medicines and surgical materials used like entry in his hospital, recorded the medical history of the treatment, performed surgery on her.

Sejal also produced reports of Zaveri Pathology Laboratory and during the investigation it was found that the laboratory was closed in the year 2019. Dr. Ankit Zaveri said that they did not write on any letterpad and it has been misused. Further investigation in this matter revealed the name of one Jasmine Patel, who had earlier worked as an administrator at Zaveri Laboratory and Sanandhi Hospital and made a laboratory report in a medical claim file during an application to the Panigate police station for further investigation.

It is to be noted here that Sejalben has hatched the entire conspiracy with the help of her husband Bhaveshbhai Kukdiya which comes to light during investigation.

The fake report of the laboratory, which has been closed since 2019, was made by Jasmine Patel, who had earlier worked as an administrator at Zaveri Laboratory and Sanandhi Hospital. The role of the doctor in this whole chapter has come out and now there will be an investigation into whether any other act like this has been done before.