Inner Mongolia police cracked down on commercial insurance fraud case after multiple people stayed in bed without being hospitalized
In an effort to mitigate financial stress during illness, many people resort to purchasing commercial insurance. However, for some, this has become a scheme for profit. Recently, the Public Security Bureau in A Rong Qian, Inner Mongolia, uncovered a case where several policyholders, after taking out multiple insurance policies, exaggerated or fabricated injury claims. After being hospitalized, they would apply for insurance payouts while only “occupying a hospital bed” without receiving actual medical treatment.
**An Unusual Spike in Insurance Claims**
In late July 2023, the A Rong Qian police received reports of multiple individuals in the area who had concentrated their insurance purchases within a short time frame. Notably, they all opted for low-cost personal accident insurance with high hospitalization benefits. After taking out their policies, these individuals quickly presented various injury claims.
Data from insurance companies indicated over 400 claims were filed in a short period, with payouts totaling over two million yuan, and 394 claims already settled. Police discovered that many of these policyholders resided in several villages within the Yadong Town of A Rong Qian.
**Frequent Claims Raise Suspicion**
Sun Shaoyong, Chief of the Economic Investigation Team at the A Rong Qian Public Security Bureau, noted, “A critical number of villagers from several villages had filed claims, creating a pattern that raised suspicions of insurance fraud.” Among the policyholders, some had purchased insurance from as many as eight different companies, while others had taken out three or four. Furthermore, they all had extraordinarily lengthy hospital stays, often exceeding 20 days, with records indicating superficial injuries like head or back trauma.
**The Hidden Truth Behind Hospital Stays**
To investigate further, police visited local hospitals and uncovered discrepancies. After interviews revealed that many policyholders were not genuinely hospitalized but merely occupying beds for the sake of filing claims, the investigation deepened. Even with minor ailments, these individuals insisted on lengthy hospital stays.
**Exploiting the System for Financial Gain**
According to interviews with the policyholders, they believed that there were no legal restrictions against purchasing multiple accident policies. Once an accident occurred, they found that hospitalization costs could be reimbursed alongside substantial daily hospitalization allowances, prompting some to see commercial insurance as a pathway to wealth.
One individual, identified as Cai, had reportedly been hospitalized multiple times in 2022 for extended periods averaging 40 days while simultaneously engaging in various transactions at local stores, indicating he was not actually receiving treatment.
**A Larger Scheme Unfolds**
Sun highlighted that while Cai pretended to be hospitalized, he was, in fact, at home engaged in his usual routines. From 2019 to 2022, Cai amassed accident insurance from multiple companies and fraudulently collected allowances totaling 145,050 yuan through bed occupancy. Additionally, he enticed family and friends to join the scheme, leading to over 200 villagers attempting to exploit the system under his guidance.
**Legal Consequences Follow**
Ultimately, more than 30 individuals were charged in connection with this case. Cai was sentenced to eight months in prison, suspended for a year, and fined 15,000 yuan for his role in this deceitful operation. The investigation revealed that policyholders profited from overlapping insurance claims, exploiting the system designed for quick financial support after accidents.
Baoci, an insurance agent, explained, “Personal accident insurance provides compensation for injuries caused by unforeseen circumstances during the validity period.” Unfortunately, in this case, individuals capitalized on these rules, showing how loopholes can lead to significant fraud.
While medical institutions are mandated to adhere to strict regulations, the presence of collusion within some medical facilities have also permitted these fraudulent activities to flourish. As outlined in the regulations, healthcare providers engaging in deceptive practices face severe penalties.
This intricate case highlights the complexities of insurance fraud, demonstrating how individuals may manipulate systems designed for support for their own gain.
