Dubai plans crackdown on fraudulent medical claims

Patients being kept in hospital longer to boost insurance claims, says top healthcare official
Dubai plans crackdown on fraudulent medical claims
(Photo for illustrative purposes only)
By Shane McGinley
Wed 26 Jun 2013 09:32 AM

Dubai is looking to crackdown on fraudulent medical claims where private hospitals overcharge for medication or patients are "over-diagnosed" and kept in hospital longer in order to boost the bill sent to insurance operators, it has been reported.

“Sometimes people are kept longer than necessary in a hospital or an intensive-care unit. These kinds of things are daily issues that insurance members face and they need to be protected," Dr Haider Saeed al Yousuf, director of the Dubai Health Authority, was quoted as saying a report by The Telegraph newspaper.

He also added that a scheme was being set up to investigate the practice by private hospitals.

It is mandatory for employers to give medical insurance to employees as part of their contract of employment, but consultants said some institutions use this as an opportunity to overcharge insurance providers.

In some cases this includes minor offences like prescribing unwanted medication or ordering expensive but unnecessary procedures, such as MRI scans.

Insurance firm InterGlobal, which has offices in the UK, Asia and across the Gulf, has highlighted this issue and said it picked up on fraudulent claims every day.

"A lot of insurers were caught out. We got on to the case and were only very lightly affected," Paul Weigall, InterGlobal's sales and marketing director, was quoted as saying.

"We are very active on the fraud investigation front. We encourage our customers, our hospitals and everyone else involved to report to us if they feel something is not correct.”

InterGlobal played a key role in uncovering one lucrative fraud where bogus claims where being submitted to insurance firms over a ten year period for a virtual hospital and non-existent consultants.

"You'll find a group of people who have built up a fabricated health care system, which will include hospitals, doctors and customers – making it very difficult for an insurer not to pay out on a claim that's submitted. Then we find that nothing of that actually exists,” Weigall said, referring to the scam as the "telephone in the desert" case.

"However, there are also hospitals that overcharge. For example, you need 20 aspirin, they charge you for 200," he added.

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