> The second method is more troubling. At altitudes above 3,000 metres, mild symptoms of altitude sickness are common. Blood oxygen saturation can drop, hands and feet tingle, headaches develop. In most cases, rest, hydration or a gradual descent is all that is needed. ...investigators found that Diamox (Acetazolamide) tablets, used to prevent altitude sickness, were administered alongside excessive water intake to induce the very symptoms that would justify a rescue call.

This doesnt sound accurate. I have trekked the Himalayas for over a decade - the risks of AMS are very real. Two people I have trekked with have died due to AMS on separate himalayan treks - both had trekked multiple times before, and were well aware of the risks. Both the fatalities were around 12000-14000 feet - much below the Everest Base Camp trek. When AMS hits, you need to descend - as fast as possible, with whatever means you have at your disposal. Otherwise you have unknowingly entered a Russian Roulette.

And Diamox is used as a preventative course for AMS - alongside excessive water intake - this is standard guidelines in all high altitude himalayan treks.

> But guides and hotel staff ... tell them they are at risk of dying, that only immediate evacuation will save them.

I got Acute Mountain Sickness at just 11k feet. Headache, nausea, dizziness, fatigue. I passed out until hitting the ground woke me up. I was very disoriented and vulnerable. If someone had told me that I had to get to a hospital or I'd die they could have led me like a tame goat. And they could be right. If you have high-altitude cerebral or pulmonary edema it is life threatening.

A guide getting a kickback can make it a lot more likely just by cutting short the boring acclimatization time.

I did the Everest base camp trek in late 2015, at that time it was quite common (saw it myself and heard about it) that people would do the trek up but to get down they would fake a leg/back injury or blame altitude sickness and the chopper from Kathmandu would come pick you up, as long as you had the right insurance.

“Wasn’t the system supposed to be fixed?“

Why would it be fixed? Insurance companies aren’t willing to invest in oversight, and everyone else profit, there is no incentive for changing the system.

> But none of that worked “The scam continued due to lax punitive action,”

It percolated up. It’s usually what happens with corruption. If lower levels are found out to have a lucrative scheme, the higher ups (auditors, police, legislators) make a big fuss about stumping it publicly, but behind the scenes go and ask for a cut.

I did the EBC trek last year and at ~4400 meters, we heard about a local Nepalese woman dying from complications of AMS in the local clinic. There might be fishy things going on with the rescues, but the health risks are real.

A story older than Nepal (misleading tourists). And an article from 6 months ago shows how the govt treats its own people with more examples in HN discussion. https://news.ycombinator.com/item?id=45166972

What is less discussed is what happened to people who were able to identify the scam and refused to let it happen.

Why is hiking the tallest mountain in the world not an insurance carve out

Make coverage void in the Himalayas... problem solved

Sounds pretty bad until you look at the numbers.

To be honest I'm surprised insurance is offered at all. I did the EBC trek a couple years ago. The temptation to take a helicopter down was real & I didn't have insurance.