Dr. Birbal uncovers a carefully fabricated Health Claim
Dr. Birbal was a seasoned investigator, and he had been asked to look into the case of Balu Sudam, who had been admitted to the Dhanvantri hospital with a diagnosis of dengue fever. Balu had claimed that he had been suffering from fever and cold for the past few days, and had self-medicated before seeking treatment at the Gunjar hospital. A blood test had been done, and his platelet count had been recorded as 40,000.
However, when Dr. Birbal looked into the records, he found several inconsistencies. For one, the hospital label on Balu’s IV stated that he had been admitted on 29 Dec 2022, while Balu had claimed to have been admitted on 26 Dec 2022. In addition, there was no record of any urine test having been conducted, and no mention of any medication being given to help increase Balu’s platelet count.
Dr. Birbal also learned that Balu was an insurance agent, and had been taking treatment for constipation for the past three years. He also had a history of alcohol consumption and had previously been hospitalized for jaundice 20 years ago. All of these factors raised red flags for Dr. Birbal, who began to suspect that the case was highly fraudulent.
To further investigate, Dr. Birbal requested the insurance papers, test reports, and first consultation documents from Balu. He also questioned him about his employment and the hospitalization history noted in his records. However, Balu was evasive and provided contradictory information, including the location of the army station where he claimed to have access to medical facilities through the ECHS and MH programs.
As he pieced together the evidence, Dr. Birbal came to the conclusion that Balu’s claim was indeed fraudulent. He had given false information about his admission date, and had not provided complete and accurate details about his medical history or employment. In addition, the lack of any tests beyond a blood test, and the absence of any medication to increase his platelet count, further supported Dr. Birbal’s conclusion.
Based on his thorough investigation, Dr. Birbal was able to help repudiate the claim, ensuring that the insurance company was not taken advantage of by fraudulent activity. Another doubt is that he may be taking benefits from ECHS as well, but we would never know about that, would we?
QuicSolv’s “Dr. Birbal stories” are true accounts of fraud detection by experienced medical professionals over video using QuicSolv’s video conferencing solutions. The names in these stories have been changed to protect the identities of those involved. These stories are meant to serve only as a learning resource and light Sunday reading.
