Netrika was tasked by a leading insurance company to visit as a customer for conducting Mystery Shopping exercise at the empanelled Diagnostic Centers (DC)

To conduct mystery shopping of empanelled Diagnostic Centers (DCs) with special emphasis on reviewing and identifying whether the collection executives of diagnostic centers are adhering to the Standard Operating Procedure & Code of Conduct on ground.

The following was taken by Netrika:

• Discrete enquiries: Telephonic enquiries were conducted in order to gather critical information on behaviour of staff towards impersonation / bribery attempts.
• Field enquiries and site visits: field investigations was conducted for reviewing practices of DCs with a special emphasis on identifying unethical business while performing their job, including if charging extra money from customers while performing their tasks.
• Information was gathered by conducting extensive inquiries and by visiting as a customer for Mystery Shopping at the Diagnostic Centers (DC).
• The entire investigation was conducted discreetly.

Our procedures helped the client in identified the following:

1. Discrete enquiries / field visits revealed that most of the Diagnostics Centers (DCs) are involved in unethical business practices or not following the laid down Standard Operating Processes of the insurance company
2. Several DCs have been identified for manipulating the clients’ history and making favourable medical reports without proper medical examinations.
3. Field visits also revealed that several DCs in non-metro cities are not verifying proper KYC documents and at several places they have conducted the medical tests of the individual other than the actual ones whose appointments are confirmed. A few DCs were also identified to be preparing entire medical report without even conducting one single medical test.
4. Several DCs do not keep sanitizers at the entry points and the lab technicians do not wear masks or hand gloves while dealing with clients. They do not keep proper distancing over the issue of pandemic.
5. During the field investigation, it was observed that in most of the DCs the lab technicians are filling up the MER. The lab technicians were also taking signature on a blank MER and in most DCs they ask only partial questions and left other to fill by themselves.
6. It was also revealed that several DCs in non-metro cities, do not have the adequate facilities such as dirty washrooms for sample collection, rude behaviour of DC technicians in respect to guidance of the clients. In few of DCs the blood & urine samples are not bar coded and they only write the name of clients who are giving the samples.

• Our mystery shopping exercise was an eye opener for the Risk & Audit Committee & appreciated the work performed and advised operations team to plug the gaps.
• The committee recommended Mystery shopping exercise to be incorporated as a mandatory process in Risk Control Unit operations on periodical basis going forward, to keep a check on the diagnostic centres functioning and place findings with action taken report in the Audit Committee regularly.