DHA staff go undercover to expose health fraud

Dubai health chiefs are fighting back against suspected insurance fraud by deploying its own staff as "mystery shoppers", it was reported on Thursday.

The move has discovered several cases of suspected insurance fraud at Dubai hospitals and clinics over the past nine months, UAE daily The National reported.

Dr Haidar al Yousuf, the Dubai Health Authority’s director of funding, told the paper that one case involved a doctor who allegedly tried to convince a patient to have an apparently unnecessary surgery that was not covered under the plan, the paper reported.

“We have three or four lines of defence that we use to monitor the situation, one of which is utilising our own employees as mystery shoppers," he told the paper.

The DHA staff also monitor prescription claims for any evidence that unnecessary drugs are being dispensed and are on the watch for any other irregularities on the part of doctors or hospitals, said Dr al Yousuf.

“We want to make sure no bad habits take root from the very beginning. The concept of insurance is still fairly new in the region and Enaya is a very new programme, so it needs to be nurtured and providers must not abuse it.”

Once a fraud is discovered, the DHA has a range of punitive measures at its disposal, from issuing a warning letter to revoking a licence, the paper said.

In November, it was reported that Daman, the UAE’s largest insurer, had toughened up its policy on fraudulent claims and had so far recovered more than $1.6m from clinics.

The insurer, which was created in September 2005 and now handles up to 700,000 claims each month, has the authority to pursue civil cases against healthcare providers suspected of committing fraud.