Daman uncovers fraud at healthcare providers

HEALTHCARE: Daman makes discoveries after 'mystery-shopping' tests conducted. (Getty Images)

Daman National Health Insurance Company has confirmed it has found cases of fraudulent practice after dispatching a team of 'mystery-shoppers' to a number of healthcare providers. 

One provider filed false information with respect to patients' symptoms, medical history and diagnoses, as well as claiming for excessive tests and treatments that were not conducted.

The company also uncovered a number of cases where pharmacies switched prescriptions based on patient requests and dispensed alternative products and cosmetics not covered by their insurance plans.

In a statement carried by news agency WAM, Daman said that depending on the severity of the case, violating providers were either issued warning letters stating that the matter would be referred to HAAD (Health Authority-Abu Dhabi) and/or frozen from operating within Daman's healthcare providers' network.

Dr. Michael Bitzer, Daman's CEO said: ''It is our duty to protect our customers' best interests; fraudulent claims that go undetected will affect the underwriting process and ultimately result in unfairly increased premiums for customers.''

He added, ''Our Medical Audit Department employs trained and experienced professionals who are constantly working on detecting and preventing abuse to ensure the highest level of services.''

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READERS' COMMENTS

Daman HAAD
Posted by Ahmed Gurab, Abu Dhabi, UAE on Monday 18 May 2009 at 20:16 UAE time


The implementation of insurance into health section, i think is the major mistake in restructuring all health services. Insurance business looks for pure profit only on the cost of human health. It prefers young healthy fit sporty individuals as the pay least premiums to those companies (like Daman). But it asks high costs and proivide restricted service payments to those elderly or frequent sick persons. It discourages expat workers or weak mothers with lot of kids and no job so they mostly suffer if one has a cancer or diabetes as the insurance tries no to pay his/her treatment at a public (if not private) health facility.

Fraudulent practices of healthcare providers.
Posted by hombil, Muscat, Oman on Sunday 17 May 2009 at 09:11 UAE time


Few months ago, similar cases were reported in the Oman media, where one clinic had claimed expenses in the name of a patient, who had not taken that particular treatment or undergone tests. After a few weeks the "sensational" case died a natural death, probably due to lack of followup from the media and/or ministry.

Well done!!
Posted by Cool, Non, UAE on Sunday 17 May 2009 at 08:13 UAE time


Cudos to Daman - well done guys!! We should see more of this type of proactive investigation/ audit across the board.

Perhaps one day we might even see police on the roads actually chasing speeding cars!! ...instead of leaving it all up those stationary cameras??

This is a great initiative by Daman!

GOOD INVESTIGATION
Posted by JRaj, Dubai, UAE on Sunday 17 May 2009 at 06:25 UAE time


The Service providers should be named and shamed they should also send the investigation team to New Medical centre the first question they ask is do you have insurance then they start the drama of ordreing all the tests possible good Job but please Name and Shame them so theat the Customers can refrain from going there

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