To safeguard integrity, there is a need for collective action from all stakeholders

PTI New Delhi

Systemic leakages due to fraud, waste, and abuse (FWA) of approximately Rs 10,000 crore each year are silently eroding trust and financial resilience within the insurance ecosystem, according to a report.

To safeguard integrity, there is a need for collective action from all stakeholders, including insurers, corporates, government, and regulators, the report, titled, Rebuilding Trust: Combating Fraud, Waste, and Abuse in India's Health Insurance Ecosystem, said.

Fraudulent behaviours, process inefficiencies, and policy violations have become embedded across the value chain, and these practices are now systemic and increasing, it added. To address this, the report outlined a three-pillar framework of prevention, detection, and deterrence, underpinned by the enablers of standardisation, technology, and data interoperability.

The report highlighted how advancements in AI and Generative AI (GenAI) can transform claims processing from a post-facto policing model into a proactive, real-time fraud prevention system.

The health insurance industry has grown to Rs 1.27 lakh crore as of 2025, reflecting an annualised growth rate of around 17% over the past 5 years, the report said.

The next 5 years continue to be promising, with the industry continuing its growth momentum by growing at a similar 16-18% ballpark, reaching approximately Rs 2.6-3 lakh crore by 2030.