Hyderabad: How bogus company cheated Niva Bupa Health Insurance of Rs 61L
A fake company under the name 'PVR Enterprises' was created and they took advantage of needy customers/patients suffering from chronic illnesses like Chronic Kidney Disease, Cancer, or Chronic Liver Disease.
By Newsmeter Network Published on 22 July 2023 4:24 AM GMT
Hyderabad: A bogus corporation duped Niva Bupa Health Insurance Company of Rs 61.87 lakh by submitting claims in the name of its non-existent employees.
PVR Enterprises managed to deceive the insurance provider of an estimated Rs. 61,87,533.
The fraud came to light when Abdullah, a 38-year-old manager at Niva Bupa Health Insurance Company Limited which has its office at Masab Tank, filed a complaint with the Masabtank police on Friday.
The complainant stated that since COVID-19, the company started receiving online applications for instituting insurance policies for needy customers on behalf of supposed employees in need.
According to the complaint, in January 2023, the fraudsters submitted 18 online Health insurance applications to Niva Bupa under the guise of being from PVR Enterprises.
They claimed to be a legitimate business entity seeking health insurance coverage for their employees under Corporate Policy/Group Policies. Over time, the scammers added more supposed employees and communicated with Niva Bupa using the email address hr.pvrenterprises@gmail.com. As a result, insurance policies were issued to these individuals, and the fraudulent company began filing claims for medical expenses on behalf of the purported employees.
In a short span of time, Niva Bupa received reimbursement requests and cashless claims for medical expenses from 23 members/employees of PVR Enterprises, out of a total of 38 members. Most of these claims were related to chronic illnesses such as Chronic Kidney Disease, Cancer, or Chronic Liver Disease, which require continuous treatment. Until May 2023, Niva Bupa received a total of 40 claims from PVR Enterprises' employees, and 29 of those claims were already approved for payment, totaling Rs. 61,87,533.
Suspicions arose when Niva Bupa decided to withhold 11 claims, totaling Rs. 19,31,763 for further investigation. Company officials visited the address provided by PVR Enterprises in the policy documents, only to discover several alarming facts:
No such company existed at the given address. The address belonged to a village approximately 30-40 km away from Chennai. The address was that of a farmhouse named Hazrath Nilayam. There was no signboard or indication of any entity named PVR Enterprises at that location.
Further inquiries revealed that a person named Rajesh Sharma impersonated the HR of PVR Enterprises, communicating with the insurance company.
Upon investigation, it was revealed that the claimants were genuine individuals suffering from health issues and undergoing treatment. However, the scammers, including Vikram Reddy Paduri who claimed to be the Managing Director of PVR Enterprises, Hanumanthu Pabathi, Rajesh Sharma, and Padmani, along with other unidentified individuals, had colluded to cheat the complainant company for financial gain.
They created a fake company under the name `PVR Enterprisesā and took advantage of needy customers/patients suffering from chronic illnesses like Chronic Kidney Disease, Cancer, or Chronic Liver Disease.
The scammers applied for Master Policy/Corporate Policy in the name of PVR Enterprises' employer and collected significant amounts from them, supposedly for treatment. However, they deceived them by posing as employees of PVR Enterprises and claimed insurance from Niva Bupa, resulting in a loss of Rs. 61,87,533/- for the insurance company.
Masabtank police said a case has been registered under sections 420, 467, 468, 471, and 120 (B) of the Indian Penal Code (IPC). The case is currently under investigation.
