Objectives: Healthcare customer fraud has emerged as a significant challenge for India's healthcare system, impacting its financial stability, operational efficiency and the quality of patient care. As the healthcare sector expands, particularly with the integration of digital health records, insurance schemes and a growing private sector, opportunities for fraudulent activities have increased. This study aims to assess the prevalence and types of healthcare customer fraud in India, evaluate its impact on healthcare institutions and examine the effectiveness of current fraud prevention measures. Using an empirical research methodology, data was collected from 412 respondents in public areas around Chennai, with a focus on demographic factors such as age, gender, education, occupation and place of residence. The study identifies key issues, including the erosion of trust in the healthcare system, inflated medical bills, false claims and unnecessary treatments, all of which contribute to financial and operational strain on healthcare providers. Despite ongoing initiatives such as the Ayushman Bharat scheme and the National Digital Health Mission, existing measures remain insufficient. The study suggests that advanced technologies like Artificial Intelligence (AI), Machine Learning (ML) and blockchain can play a crucial role in improving fraud detection and prevention. Furthermore, strengthening regulatory frameworks, increasing public awareness and fostering public-private partnerships are vital to mitigate fraud risks and enhance the integrity of the healthcare system. The findings underscore the need for comprehensive policy reforms to safeguard the healthcare system’s sustainability and effectiveness, ensuring a more transparent and reliable healthcare environment for all stakeholders.
Selvamuthu et al. (Tue,) studied this question.