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The Middle East's Leading English Language Daily
Monday 24 November 2008 (27 Dhul Qa`dah 1429)
Fraud rampant in health care, say insurance experts
Sarah Abdullah | Arab News —
JEDDAH: As unfortunate as it is, fraud is becoming a problem in the health
insurance sector. Those at fault, local insurance experts say, are usually the
private sector health care facilities that resort to such activities to make a
profit, leaving unsuspecting patients unaware that they have been ripped off.
According to statistics, health care fraud is one of the main challenges faced
by the global insurance market today, amounting to a loss of at least 5 percent
of all international premiums with between 6-15 percent of gross claims paid in
various countries. Types of global fraud include doctor hopping, denial of
pre-existing conditions, misapprehension of facts about illnesses and providers
changing treatment descriptions.
The most common schemes found in Saudi Arabia, local insurance experts say, are
unnecessarily large-scale orders for medical examinations, such as laboratory
tests, MRIs, X-rays and CAT scans.
Another fraudulent scenario is “medication substitution.” Some private health
facilities have been caught instructing doctors to prescribe expensive
medicines and then allowing pharmacists to switch them with low-cost brands.
Acknowledging that fraud exists in the Saudi market, Mahmoud Awan, corporate
marketing manager of BUPA Arabia, said, “The health insurance concept is
relatively new to our society. There may be some people misusing it due to a
lack of understanding of the process.”
He added that he expects time, information and experience to be involved in the
preparation of properly utilizing the benefits of the health insurance system.
Raeed Al-Tamimi, vice president of Tawuniya, told Arab News: “Once a fraudulent
act is discovered it will only lead to rejection of the claim and no
compensation will be paid out.”
Speaking about measures that Saudi insurance companies follow to cut down on
fraud, Al-Tamimi said: “Upon receiving requests for approval or bills from
health care providers, our doctors carefully evaluate them. If there is any
suspicion, an investigation will be carried out by our Fraud Review Unit.”
However, Awan said one of the first and most important things insurance
companies can do in combating fraud is increasing social awareness and opening
communication channels between insurance companies, patients and health care
providers. “Fraud can be detected at various stages by verification of
identity, following international guidelines and transparent communication
between the concerned parties,” he said.
Awan said his company was exploring deployment of advanced technology, such as
swipe cards and fingerprinting, with an aim to replace current verification and
photocopying needs. “The move will considerably cut down waiting time at
reception,” he said.
Al-Tamimi said Tawuniya has been able to detect numerous fraud attempts and
terminate contracts with some local health care providers who were resorting to
fraudulent billing practices.
He pointed out that work is being done to increase the ability of staff by
conducting training courses in cooperation with Naif Arab University for
Security Sciences in order to familiarize the personnel with the concepts of
forgery, kinds of fraud, methods adopted for preservation of records, warranty
signs and electronic data, vital standard measurements and combating
falsifications.
He said Tawuniya had also begun implementing a rewards mechanism for reporting
fraudulent claims.
Nonetheless, Al-Tamimi said with all of these safeguards in place to help
combat fraud, the first line of defense in protecting the Saudi market and
consumers should be good faith. He also said that insurance fraud is considered
a criminal act globally.
Copyright: Arab News © 2003 All rights reserved. Site designed by: arabix
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Jusfiq Hadjar gelar Sutan Maradjo Lelo
Allah yang disembah orang Islam tipikal dan yang digambarkan oleh al-Mushaf itu
dungu, buas, kejam, keji, ganas, zalim lagi biadab hanyalah Allah fiktif.
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