Hospitals in the UAE are overbilling patients and insurance firms either in error or in deliberate fraud, National Health Insurance Company, also known as Daman, has reported.
An umbrella for medical insurance in the second largest Arab economy, Daman said it recovered nearly Dh29 million from health service providers who overbilled patients, both by mistake as well as to inflate their own profits.
“These funds were a result of fraud, manipulation and errors in billing by medical service providers,” Daman’s CEO Michael Bitzer, told the Al Khaleej daily.
He said nearly 20 per cent of those funds were a result of fraud and manipulation while the rest were due to errors in billing for patients.
Bitzer said Daman’s claims on government health institutions increased sharply to around Dh19.9 million in 2012 over the previous year.
He gave no figures for 2011 but said the surge was a result of a large increase in the number of clients and changes in billing by some service providers.
According to Daniel Whitehead, Mena Region Healthcare Lead for consultants Booz Allen & Hamilton, the Gulf region may be losing more than Dh3.67 billion ($1 billion) on health insurance abuse or fraud.
In a survey of 450 respondents conducted by 999 magazine, the official English monthly of the UAE Ministry of Interior, more than a quarter (28 per cent) of respondents affirmed that they have experienced being advised and billed to undergo unnecessary tests that only inflate the bill.
The misuse of health insurance coverage in the UAE is pushing up costs that lead to fewer benefits and/or higher premiums for the companies and for the insured person who makes a co-payment, the magazine said.
The UAE’s healthcare sector is booming, with a projected 271 per cent growth by 2015, up from $3.2 billion to $11.9 billion; and hand in hand with that growth comes the rise of health insurance, a benefit that all nationals and most employed expatriate residents get.
The flipside is that the misuse of this health coverage means healthcare benefits for UAE citizens and residents are being eroded in value by unethical and fraudulent claims.
The cost of paying out unfair claims is ultimately recovered through higher premiums – fraud and misuse, therefore, rob those who really need the cover. It was reported that thousands of workers in Abu Dhabi might have their health benefits cut as employers were looking to manage premiums that had gone up by about 20 per cent.