Insurance claim investigation, audit and vigilance
We help insurers, TPAs and government schemes settle genuine claims and stop fraud, with every finding backed by documents, records and field evidence.
Working with
- Insurance companies
- TPAs
- Government health schemes
What every engagement delivers
Accurate assessments
Every claim verified against documents, records and field evidence.
Fraud prevention
Early detection of inflated, fabricated or colluded claims.
Faster turnaround
Streamlined processes that keep settlements moving.
Evidence-based reports
Clear findings that support confident claim decisions.
Six service lines
From a single hospital claim to a full vigilance function inside your organisation.
- Health & Personal Accident InvestigationCashless, reimbursement, critical illness and accident claims.
- PMJAY Policy AuditHospital, desk and tele audits under Ayushman Bharat.
- Motor Claims VerificationMBV, DCV, theft and own-damage verification.
- Death Claim InvestigationDocument cross-checks, field and forensic review.
- Manpower Supply to InsurersTrained staff deployed to insurance companies.
- Internal Vigilance DepartmentFraud detection and compliance for insurers.
PMJAY policy audit, in five layers
Five layers of audit under Ayushman Bharat, from the patient's bed to the post-discharge call, so that scheme money pays only for treatment that was actually delivered.
Explore PMJAY auditOn-bed live medical audit
Checks package mismatch, patient absence, impersonation, out-of-pocket charges and report authenticity.
Hospital infrastructure audit
Verifies facilities, staff, equipment and treatment quality against empanelment norms.
Desk medical audit
Rules out up-coding, package bundling and procedure mismatch before payment.
Tele & video-call audit
Post-discharge calls to confirm treatment, satisfaction and no extra charges.
Grievance handling
Resolves audit-related grievances raised by hospitals and State Health Agencies.
How a death claim investigation runs
An evidence-based process to confirm the authenticity of every death claim.
- 1Verify claim authenticity
- 2Cross-check documents
- 3On-ground investigation
- 4Medical & forensic analysis
- 5Evidence-based report
Transparent findings that help insurers settle genuine claims quickly and stop fraudulent ones.
Have a claim that needs a second look?
Send us the claim details and we'll tell you how we'd investigate it and when you can expect the report.