Public health insurance schemes in Nagaland have hit a roadblock after private insurer Future Generali India Insurance Co. Ltd (FGI) allegedly withheld claim settlements, citing “fraudulent claims” by some hospitals. In response, the state health department has urged private empanelled hospitals to continue offering services while efforts are underway to resolve the payment dispute.
The Nagaland Health Protection Society (NHPS), the registered agency under the state health and family welfare department administering the health protection schemes, said on Thursday that the prolonged delay in settling “legitimate” claims by FGI was causing operational and financial stress for empanelled hospitals, thereby affecting beneficiaries.
FGI reportedly raised concerns in December 2024, flagging suspected fraudulent claims through what it called “fraud dossiers”. NHPS said it had acted immediately, conducting independent audits and verifications through internal teams and district authorities.
The delays pertain to claim settlements under two key government health schemes — the Chief Minister Health Insurance Scheme (CMHIS) and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
“This delay is further exacerbated by FGI’s lack of cooperation, despite earlier mutual agreements to resolve such issues through joint audits,” the NHPS statement said.
It added that despite the state government’s assurances of cooperation in identifying fraudulent claims and initiating punitive action — including commitments from the Nagaland Private Doctors’ Association (NPDA) — FGI has not responded to repeated requests to process and release genuine claims without arbitrary rejections.
So far, the NHPS has suspended two hospitals for six months and initiated recoveries from two others. “This is an ongoing exercise and further recoveries will be made against claims found to be fraudulent beyond doubt,” the statement said.
The NHPS issued an “earnest appeal” to all Private Empanelled Health Care Providers (EHCPs) in the state to continue providing services under the scheme.
The appeal came a day after the NPDA announced that private EHCPs would suspend CMHIS and AB PM-JAY services from April 17.
“In the event any empanelled private hospital within the state is unwilling to provide cashless services, beneficiaries are advised to visit any government hospital, CIHSR Dimapur, or empanelled hospitals outside the state,” the NHPS said. These institutions will continue to offer uninterrupted and fully cashless treatment under the schemes. A helpline (1800-202-3380) has been issued for support.
