False Pretenses: An Infertility Scheme Unveiled

Dr. Birbal, appointed by an insurance company, conducted a remote video call with a patient named Renu Yadav. Renu’s husband provided information about her recent symptoms, including abdominal pain, back pain, vomiting, and loose motion.

Dr. Birbal used his natural ability to befriend and engage in a casual conversation to get to the root of the problem. He probed Renu about her medical history and found out that she had been admitted for infertility treatment but was showing treatment for diarrhea and vomiting, potentially attempting to scam the hospital.

Further investigation revealed that no tests had been done regarding Renu’s age, despite her severe loose motion and abdominal pain, and no ultrasound or stool test had been performed. Renu’s medical records also showed that she had two pregnancies and one abortion, despite denying any previous pregnancies or abortions. There was also a discrepancy with her room admission, as she had been approved for a single room on pre-authorization but was instead admitted to the general ward.

Dr. Birbal recommended masking the admission, as it appeared that Renu was admitted for infertility treatment but showing treatment for an unrelated ailment. He also noted the lack of tests and discrepancies in the patient’s history. Ultimately, the insurance company repudiated the case based on Dr. Birbal’s final recommendations.

This case shows the importance of thorough investigation and analysis, even in seemingly straightforward cases, to ensure the proper use of insurance resources and to prevent fraudulent claims. Dr. Birbal’s keen eye and friendly approach helped identify potential fraud and led to a successful resolution for the insurance company.