Mumbai: Doctor, Associate Booked in Alleged Rs 5 Lakh Fake Medical Insurance Claim Case

A shocking case of alleged medical insurance fraud has come to light in Mumbai’s Jogeshwari area, where a former employee’s identity was allegedly misused to obtain a Rs 5 lakh medical insurance policy and submit a fake surgery claim to an insurance company. The Meghwadi Police have registered a cheating case against two persons, including a private hospital doctor.

The accused have been identified as Vishalbabu Ramji Gupta and Yogesh Shukla. Police are expected to question both accused soon and are also investigating whether similar fraudulent claims were made using the identities of other current or former employees.

According to the police, complainant Prakash Patil, a resident of Kanjurmarg, had earlier worked as an office boy at a private hospital in Jogeshwari. He had left the job last year. In May 2025, he received a phone call from a hospital employee, Fatima Khan, asking him about his medical insurance policy. Patil informed her that he had never applied for any medical insurance.

During the conversation, Fatima allegedly told him that Dr. Vishal Gupta had already taken a medical insurance policy in his name. Suspicious about the claim, Patil asked her to send him the insurance documents. After receiving the documents on WhatsApp, he was shocked to find that a medical insurance policy had indeed been issued in his name by a private insurance company using his personal details, including his date of birth and company information.

However, Patil claimed he had never worked for the company mentioned in the documents and had never submitted any papers or undergone any medical tests for insurance purposes.

Suspecting foul play, Patil contacted the insurance company’s customer care department. During the inquiry, he was informed that a Rs 5 lakh policy had been issued in his name and that a surgery had allegedly been performed on him on January 13, 2025, at a hospital in Kharghar, Navi Mumbai, under a cashless scheme. The insurance company further revealed that a claim amount of Rs 3.56 lakh had been processed, out of which Rs 66,000 was transferred to the hospital’s bank account as settlement.

Patil was also informed that the surgery was allegedly conducted by Dr. Yogesh Gupta. After receiving the related documents from the insurance company, Patil was left stunned as he had never undergone any surgery, nor had he ever been admitted to the said hospital.

The complainant further alleged that the insurance company had processed the claim without verifying the facts with him. When he contacted Dr. Yogesh Gupta regarding the matter, the doctor allegedly denied any involvement and advised him to speak with Dr. Vishal Gupta.

Following further inquiry, Patil alleged that Vishal Gupta and Yogesh Shukla had conspired to obtain a fake medical insurance policy in his name and prepared forged documents showing that he underwent surgery in order to fraudulently claim insurance money.

Based on Patil’s complaint and preliminary verification, the Meghwadi Police registered an FIR against both accused for cheating and forgery.

Police are now probing whether the accused had similarly used the identities of other current and former employees to fraudulently obtain medical insurance claims. Investigators suspect the involvement of an organised fraud racket and are also examining whether other doctors and hospital staff were part of the conspiracy.