Revealed: How the Gulf is losing billions to medical insurance fraud

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On a recent trip to a local clinic, seeking treatment for a summer flu and upset stomach, I was put on a drip, given a number of blood tests, an ear waxing treatment and returned home laden with four different types of drugs.

“Do you want anything stronger?” the doctor asked as I left. I politely declined.

Upon telling my story to a neighbour, she recounted how a dentist had asked her if she only wanted the standard clean, or wanted to use up the maximum cover on her insurance to go for something else. Seventeen fillings later and my neighbour looks like she has joined the new celebrity trend and got herself a fashionable grill.

This a la carte approach to healthcare may seem innocent enough, but the bill ultimately has to be paid somewhere down the line. At a time when competition among insurance providers is increasing and margins are being squeezed, the industry is calling for a clampdown on systemic abuse and more regulation of claims that are clearly fraudulent in nature.

The zeros certainly begin to add up. Figures quoted by the Health Insurance Counter Fraud Group (HICFG) show that fraudulent medical insurance claims cost the US government up to $175bn a year, while cash-strapped providers in Europe are being hit with a bill of anywhere between $40bn and $132bn a year.

In the Gulf, statistics are difficult to come by, but a report by consultancy group Booz Allen Hamilton estimated that the UAE was losing more than AED3.67bn ($1bn) on health insurance abuse or fraud.

The results of a survey published earlier this year by 999 magazine — the official English-language monthly of the UAE Ministry of Interior — found that 28 percent of the 450 participants surveyed said they have been advised to undergo unnecessary tests or procedures that were clearly designed to simply inflate the bill the provider would submit to the insurance company.

Around half of those surveyed also said they knew someone who had submitted a fake sick note. In most cases, not only is the industry being hit, but productivity is also affected. Earlier this summer, official figures from Kuwait’s Civil Service Commission found that public-sector employees claimed more than 120,000 sick days during the holy month of Ramadan and in the four days immediately after the Eid Al Fitr holiday, leaving the Gulf state with a bill of over $11m in lost productivity.

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Posted by: F backer

Let there be chain of more government subsidised hospitals / clinics and let insurance companies divert their members to these government hospitals rather than private hospitals who are the real beneficiaries. In this case the government hospitals can cover the treatments at reasonable rates. This will enable profitability for insurers and possible reduction in premiums for end users.

If the premium increases 20 percent compounded yearly then employers will be forced to make drastic decisions on cost cutting and possibly close .

No need to pay millions to big consultants to solve this issue.

Wishing the general public access to basic health care at reasonable cost if not free at least and make this region one of the most attractive place on planet to live, work and do business.

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