Four people swindle lakhs from medical insurance companies using fake claims throughout the pandemic, get caught thanks to their greed
(Far left) Sanjaykumar Dixit, who was assaulted for rejecting claims of the accused; (centre) Dr Rohit Mishra, main accused; (right) accused Bharat Mishra is the co-owner of F-9 Healthcare; (left) accused Simanchal Mishra owns Sivansh Lab
The Mira Road police have busted a mediclaim racket run by a doctor and a few diagnostic lab owners following the kidnapping of an inspection officer of an insurance firm. The complainant was assaulted for rejecting bogus claims raised by the doctor and his men. The police have arrested three people, including Dr Rohit Mishra, and are on the lookout for the fourth accused.
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Other than Dr Rohit, who is attached to a few well-known hospitals in Mira-Bhayandar area, the other two arrested accused have been identified as Simanchal Mishra, owner of Sivansh Lab, and Bharat Mishra, co-owner of F-9 Healthcare Lab. Bharat’s partner Rajesh Mishra is absconding. Apart from producing fake medical bills, the four allegedly tried to make money by duping insurance firms by showing the same person admitted to different hospitals. They also connived with people with medical insurance and helped them file bogus claims during the Covid pandemic.
Complainant Sanjaykumar Dixit, 40, who works for a leading insurance company, filed a complaint on March 17, alleging that he was abducted and assaulted. Dixit’s job is to make sure mediclaim papers and bills are in order before they are sent for processing the disbursal of the amount. In this case, Dixit told the police that he had visited a hospital in connection with a cashless claim of about Rs 2.5 lakh of a patient. However, Dixit later learnt through his juniors that another claim had been filed for the same patient with a different insurance company. This made him reject the cashless claim.
Dixit was assaulted in a moving car on March 16 (right) Accused Rajesh Mishra, who is on the run
Dixit said he was at a tea stall near RBK School, Bewrali Park area in Bhayandar, on March 16 when Simanchal called him up saying he wanted to meet him over insurance claims. After some time, Simanchal, Dr Rohit and Bharat reached the spot. Dr Rohit asked Dixit to sit in his car. “As soon as I sat in the car, Rajesh Mishra and Simanchal Mishra sandwiched me in the rear seat. They started abusing and assaulting me saying why I was not processing claims being sent through them,” Dixit said. He was then allegedly taken towards the Seven-Eleven Club where more people joined them in beating him. Dixit was finally dropped off at the east side of Bhyandar station. “The four threatened me not to approach the police. They forced me to say that I had deliberately rejected their claim for a bribe and filmed it,” said Dixit in his complaint.
Dixit told mid-day, “The accused have been cheating health insurance companies for years. We lost a lot of money due to fake customers and claims, especially during the Covid pandemic. As an insurance officer, it is my duty to investigate the cases that come for claims. In the past, I had rejected a fake claim of these people after investigation.” He added, “They tried to get me involved in their conspiracy, lured me with money, but I did not listen to them.”
Why Dixit rejected the claim
Dixit said Dr Rohit’s relative Arpit Mishra was Covid-positive and was admitted to the Metro Life Care Hospital in February. “I visited the hospital on February 2 and checked his cashless claim papers and found them in order. But in the meantime, I learnt that the same patient’s reimbursement claim for the same period has been applied from another hospital [Jugara Hospital]. I had to reject the claim,” he said, “I have rejected 15 to 20 fake reimbursement claims and saved about R20 lakh from being usurped. Angered by this, they attacked me.”
Dixit said he spoke to a lawyer who asked him to approach the police. “The next day, I along with my lawyer Shambhu Jha went to the Mira Road police station and filed a complaint,” said Dixit. “In recent time, a huge mediclaim scam by hospitals have been exposed. Laboratories are involved in it. If a dedicated claim investigator like the present victim doesn’t support them, they take the law into their hand,” said advocate Jha. Dattatrey Sonwalkar, assistant police inspector of Mira Road police station, said, “The accused have been remanded in police custody till March 24.”
Mar 16
Day Sanjaykumar Dixit was abducted and assaulted
24 Mar
Date till accused will remain in police custody
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