The Delhi Medical Association Nursing Home Forum (DMA NHF) has lodged a formal complaint with the Insurance Regulatory and Development Authority of India (IRDAI), alleging that health insurers are engaging in cartel-like practices through the General Insurance Council (GIC).
In its representation, DMA NHF urged IRDAI to examine charges of cartelisation, curb alleged abuse of market dominance by insurers, mandate fair and inflation-linked tariffs for hospitals, and safeguard patient interests by ensuring uninterrupted cashless services. The Forum also pressed for a Serious Fraud Investigation Office (SFIO) probe into the insurers’ conduct.
According to the complaint, the GIC has introduced a “common empanelment” mechanism that enables insurers to collectively fix tariffs and dictate commercial terms, undermining hospitals’ freedom to negotiate independently. DMA NHF maintained that such collective bargaining lacks legal validity, breaches competition norms, and is detrimental to healthcare delivery.
“With private insurers accounting for more than half of India’s health insurance market, they are abusing their dominant position to impose one-sided tariffs. The so-called common empanelment strips hospitals of their negotiating rights, keeps tariffs artificially low, and jeopardises the sustainability of quality healthcare. Rather than serving patients, insurers are using IRDAI’s circulars as cover to justify cartelised behaviour, which runs contrary to both the Competition Act and IRDAI’s mandate,” said Dr. V.K. Monga, Chairman, DMA NHF.
The Forum further highlighted that hospitals are being forced to provide cashless treatment under lapsed agreements at outdated and unviable rates, warning that this practice compromises patient care. It noted that India already has some of the lowest hospital tariffs globally and that further suppression could deter investment in healthcare infrastructure and modernization.
Pointing to inefficiencies in the insurance sector, DMA NHF stated that a significant portion of policyholders’ premiums is spent on commissions and administrative overheads rather than on patient care. For FY 2024–25, the incurred claims ratio (ICR) of leading standalone health insurers reportedly ranged between 54% and 67% of total income.
“This suppression does not benefit policyholders. Insurers are prioritising profits over patient welfare. We are raising this issue in the larger interest of hospitals, nursing homes, healthcare providers, and above all, patients. Anti-competitive collusion under the GIC endangers not only providers and patients but the entire healthcare ecosystem. We call upon IRDAI to take urgent action to restore fair practices, secure provider sustainability, and protect patient rights,” Dr. Monga added.