Health Insurance Board Investigates Maternity Claims Filed Under Names of Male Policyholders

Kathmandu — Records found in the Health Insurance Board’s online system show claims were submitted for maternity and Caesarean section services under the names of male policyholders. The records indicate that claims were filed for insurance payments showing male beneficiaries as having given birth and undergone Caesarean procedures.

According to the records, a claim was submitted under the name of Shravan Kumar Poudel, whose NSHI number is 064268888, stating that a child had been delivered through a Caesarean section. The system shows that Poudel was admitted to a hospital from January 17 to 20, 2024, and received Caesarean section delivery services during that period.

A claim of NPR 17,545 was submitted under Poudel’s name for the service. The system also shows that he received health insurance services from healthcare facilities including Nagar Hospital in Birtamode.

Similarly, a claim was found under the name of 36-year-old Shyamsundar Nakarmi, whose NSHI number is 022598888, stating that he had received normal delivery services. Under claim number 300508888, the system records that he was admitted to a hospital from August 24 to 26, 2018, and received normal delivery services.

A total of NPR 7,000 was claimed under Nakarmi’s name, comprising NPR 5,000 for normal delivery and NPR 2,000 for hospital admission charges. The system shows that the Board approved NPR 5,000 of the claim.

According to the Board’s assessment, the NPR 5,000 claim for normal delivery was approved. However, the NPR 2,000 claimed by the hospital as daily admission charges was rejected because such charges are included in the maternity service package.

Board Acknowledges Claims Were Against Standards

The Health Insurance Board has also acknowledged that claims for maternity and Caesarean services under the names of male policyholders appear to be contrary to established standards.

Bikesh Malla, information officer at the Board, said the Board was aware of claims for maternity services being filed under the names of male policyholders and that a detailed investigation was underway.

According to Malla, the claims appearing under the names of Nakarmi and Poudel appear to violate the applicable standards. The Board said that even if the wife of a male policyholder has undergone childbirth, maternity services received by the wife cannot be claimed under the husband’s name.

Malla said the Board also seeks necessary information from the concerned healthcare institutions when investigating such cases.

He said some records from before 2024 have been difficult to access because the Board’s server crashed that year. “We are conducting detailed investigations into such cases. We also question some hospitals,” he said.

Records show that Nakarmi received health insurance services from healthcare institutions including Patan Hospital. His health insurance card is currently reported to be inactive.

Board Pays More Than NPR 9.73 Billion in Outstanding Claims

Meanwhile, the Health Insurance Board has paid NPR 9.7329 billion in outstanding claims owed to healthcare service providers.

The Board said the amount, totaling NPR 9,732,929,778.60, was transferred to the bank accounts of the concerned healthcare institutions on September 23, 2026, from the approved budget and funds released for the current fiscal year 2026/27.

The outstanding claims from fiscal year 2025/26 had initially been estimated at more than NPR 14.51 billion. However, following verification and scrutiny, the Board said only NPR 11,531,592,060.39 was approved as payable.

Of the more than NPR 11.92 billion released by the District Treasury and Comptroller Office, the Board had already paid more than NPR 9.2385 billion.

From the remaining approved amount, payments were reduced for certain institutions with outstanding advances from the month of Asar, those that had not provided bank account numbers and those whose payments had been withheld under specific decisions. After deducting the required two percent fund contribution in accordance with Board regulations, more than NPR 9.73 billion was paid to the healthcare institutions.