Additional reporting by Richard Bull in Kathmandu

Rescue in the Himalaya is changing. The extraordinary escape of three climbers stricken with frostbite and altitude sickness at almost 7,000m on Annapurna in 2010 is a great example. In the past, they would probably have not survived, yet a powerful Ecureuil B3 helicopter plucked the three men to safety in the nick of time. The Swiss team – pilot Daniel Aufdenblatten and rescuer Richard Lehner from Air Zermatt – were in Nepal to train local helicopter crews in rescue techniques when they got the call. “Until then,” Aufdenblatten said, “helicopter rescues at those altitudes had been regarded as impossible.”

The rise of Nepal’s helicopter industry

Nepal’s civil aviation industry has flourished since the end of its civil war in 2006. With tourism numbers doubling, especially on Everest, the demand for medical evacuations has risen dramatically. Every year, over 100,000 trekkers visit Nepal, and more of them are requiring helicopter rescues. This sounds like a good thing — but there’s a catch.

Weak regulation and easy access to insurance money have turned rescues into a lucrative business. Middlemen and agents, eager for commissions, have created a competitive industry, playing helicopter operators against one another. Even trekking guides and agencies are getting in on the act.

David Hamilton, an experienced guide for Jagged Globe, highlighted the growing problem early on: “Imagine you’re a local guide leading a trek of six people for a fairly low-budget outfit. The agent will only be making $500 out of the whole deal. You’ve got someone who’s going a bit slow and it’s a pain waiting for them, you tell them they’ve got altitude sickness, you call in a helicopter and your company gets ten or 15% of what, $10,000? In a couple of years, when the insurance companies start looking at the books, there’s going to be a massive price hike.”

The cost to insurance

The impact on insurance is now being felt. Premiums for travel insurance to Nepal, particularly for trekking, have soared. While it’s great to have better emergency coverage, rising expenses mean higher premiums.

The real question is whether the increased premiums are covering legitimate rescues or funding fraudulent activity. According to a helicopter pilot based in Nepal, kickbacks, haggling, and inflated costs are rampant. “A client getting sick is good for the trekking companies,” the pilot said. “A client may be paying $1,500 for a trek in the Everest region, but if he gets sick the [trekking] company might make $2,000 or $3,000 out of it from the rescue helicopter.”

How fraud is impacting trekkers and insurance companies

Trekkers rarely carry the phone numbers of local helicopter operators. Instead, they depend on their guides to make the call. Some guides work with charter companies or directly with helicopter operators, negotiating the best price — and commission — for the rescue.

Not only does the charter company haggle over the price, according to the pilot they also request a fake bill. “If you don’t agree then you don’t get the business. Even if we fly only two hours, they ask for a bill for five hours. Nowadays they don’t even ask for the bill, they give their own bill.”

Helicopter companies in Nepal face high operating costs, including insurance rates of 15% of the helicopter’s value per year, which can amount to $375,000. Meanwhile, middlemen and agents are reaping profits without any significant investment.

What can be done to curb the fraud?

Insurance companies can take steps to prevent inflated rescue costs. The pilot suggests asking for detailed flight logs, which are difficult to fake. “There are only certain companies here making rescue flights. You can ask which company made the flight? How many hours did it fl y? Ask for the check log. We write everything down. I can’t fake the check log. If I write ten hours instead of two hours, then the helicopter has to be serviced eight hours earlier.”

The pilot estimated that around 1,500 tourist emergency flights are conducted each year, primarily for trekkers. That’s millions of dollars of commission up for grabs, so it’s hardly surprising that the growth of Nepal’s private helicopter sector has attracted middlemen looking for a slice.

So much for sharp practice, what about outright fraud? Are all those ill people getting a ride home really sick? “I cannot say by looking at their faces,” the pilot says. “Half look quite fit but I cannot decide. I just fly the helicopter – I’m not a doctor. The agents will have called an ambulance, they take them to CIWEC (the reputable and longstanding travel medicine centre near the British embassy) or an international clinic, they go there and get certified as sick.” But, he says, the evacuation of healthy people happens: “A lot.”

There seem to be at least five categories of fraudulent use of insurance policies to profit from helicopter rescues: unnecessary evacuations, fast rides down, overcharging rescues, charging twice for the same rescue and deliberately scheduling ‘rescue’ flights into trekking itineraries. Researching this article, we found direct evidence for all of them.

Unnecessary evacuations and fraudulent claims

According to Prakash Adhikari, chief executive of the Himalayan Rescue Association (HRA), helicopters have complicated the work of organisations like the HRA, which operates health posts along popular trekking routes. In the 2012 autumn season, HRA authorised only 15 helicopter evacuations, mostly for serious altitude-related conditions like HAPE (high-altitude pulmonary edema) and HACE (high-altitude cerebral edema). Yet, many trekking guides bypass these health posts, fearing the HRA won’t authorise an evacuation that could result in a large commission.

One paramedic shared a story of a trekker feigning illness to secure a helicopter evacuation. Others report that some patients evacuated by helicopter were perfectly healthy. According to a doctor in Kathmandu, 20% of those evacuated didn’t need a helicopter at all.

How to protect yourself from fraud on your next trek

Helicopter rescues have become an essential part of high-altitude trekking in Nepal, but they come with risks — including higher insurance premiums and the possibility of fraud. To avoid falling victim, choose a reputable trekking company, prepare thoroughly, and familiarise yourself with proper acclimatisation techniques.

The bottom line? While helicopter rescues offer a vital safety net, the increase in fraudulent claims could put your health and holiday at risk — and cost you more in insurance premiums.

The scams

1 - Unnecessary Evacuation of someone who would recover

Inexperienced trekkers can be persuaded by lodge owners or trekking guides that they need treatment in Kathmandu, when descent or analgesics would suffice. That treatment can often be hugely profitable: a straightforward check-up following evacuation can cost up to $800 and two or three days in hospital $5,000. At least one helicopter-charter company now has its own medical facility where patients are delivered after being evacuated – a new twist on unscrupulous cab drivers taking you to his ‘brother’s’ hotel.

2 - Overcharging for the rescue

This can work in other ways. Lodge owners calling in a chopper for a stricken guest have been known to ask for goods to be flown in on the incoming flight, and tourists in the area may find themselves being offered a cash-in-hand ride back to Kathmandu.

3 - Charging twice for the same rescue

An organiser in the Manaslu region arranged a helicopter evacuation for two clients – from different countries – suffering from altitude sickness. He learned later that both insurance companies had been billed for the entire $5,000 cost of the charter, totalling $10,000. The profit on the deal would have been around $7,000.

4 - Trekkers or climbers looking for a fast ride down following an expedition

With the right contacts, it’s not difficult to get what looks like bona fide documentation saying that a rescue was medically justified and the insurance company picks up the bill. This isn’t confined to Nepalese trek leaders

5 - Deliberate scheduling of a ‘rescue’ flight in a trekker’s itinerary to save them time

This was offered without prompting to a Dutch group planning a complex itinerary in the Kangchenjunga area. When they decided to include two friends for part of it, they received an email from their agent:

“In the beginning they have to pay helicopter cost in Nepal, when they completed there [sic] trekking and arrive in Kathmandu I will make the doctor report saying that we need to rescue the people from Ghunsa because they are ill and the aviation people will too make the certificate saying that we are rescuing these people.”

The plan, the agent says, will be ‘a good solution for them,’ and to reassure their prospective clients, the agent goes on to say: ‘I started Nepal tourism business since 1990 most of the time I did the same like this and there was no problem at all till now.’