A family of seven members and an employee of a third-party administrator insurance company, based in Andheri, have been booked by the police under the charges of criminal conspiracy and cheating the company to the tune of Rs. 31.28 lakhs.
The complainant, Pramoad Turbhe, who works as Assistant Vice President at the company - Vidal Health Insurance - approached the Andheri police on Tuesday, and registered a first information report (FIR) against eight people. They are identified as Rajkumar Gaud, Sushila Gaud, Aarti Gaud, Kavita Gaud, Meena Gaud, Sunita Gaud and Kusum Gaud. The eight accused - Ajit Pujari, who is an employee at Vidal Health Insurance.
Details of the fraud
The Gaud family in total made 26 insurance claims from the period August 2020 to June 2022. These claims were for coverage or compensation of medical procedures. The FPJ has the copy of the FIR, which shows that all of the claims are made under several hospitals based in Andheri, Malad, Kandivali, Virar, Vasai, etc. These claims, in total, amounted to Rs 32,95,221, which the company after deducting some amount, paid Rs 31,95,221 to the Gaud family.
The company failed to realise the fraud as the Gaud family submitted every document in a timely manner, until in September 2022, the chairman of Vidal Health Insurance received an email that said one of their employees is helping "several" clients by making forged documents and helping them with bogus claims. The mail also mentioned the Gaud family and how they received claim money on the basis of forged documents.
The company initiated an internal investigation in the matter. They checked with all the hospitals that the Gaud family mentioned in their claims, which as expected turned out to be bogus. Some hospitals mentioned by them were closed down long back, said Turbhe in his statement to the police.
The family and employee booked
The entire family, residents of the western suburbs, and the employee, have been slapped with offences including 120B (criminal conspiracy), 420 (cheating), and other relevant sections of forgery under the Indian Penal Code. As of Wednesday, no arrests have been made by the police but a formal investigation has been initiated by them.