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16 April 2024

Are some UAE hospitals guilty of cheating desperate patients - and insurance fraud?

By Shuchita Kapur

Some private hospitals in the UAE are apparently making money by fleecing patients through different hidden charges and unnecessary medical treatments in the name of providing quality treatment, it is emerging.

Playing on the emotions of concerned parents, a spouse or relatives, some doctors exaggerate the medical problems of a patient for unnecessary medical treatment and sometimes even go to the extreme of diagnosing them of problems that never existed in the first place, claim some residents.

So if it comes to a choice between treating one's little one at home and admitting her to the hospital because the doctor says he suspects a severe ailment, most parents in the country won't think twice before agreeing for the latter as they are covered by medical insurance, they point out.

The question, however, is how often are these diagnosis biased, conveyed to hapless parents or caregivers in a more frightening tone than they would warrant?

A reader of Emirates 24|7 spoke of her experience at a prominent hospital in Dubai. "My two-and-a-half-year-old daughter suffers from childhood asthma. Her regular paediatrician was out of the country, so we took her to a nearby hospital, which is supposed to be a good one," she said on the condition of anonymity.

"We thought she was down with normal cold and flu but the doctor at the hospital scared us. They sent my daughter for a chest X-ray, and the doctor told me she was suffering from pneumonia and that he could see white patches in her lungs. 

"He recommended immediate treatment with IV antibiotics as, according to him, the option of administering medicines orally was a bit too late and considering her age, he recommended immediate admission to the hospital. They kept her in the hospital for two days and one night, but the treatment was lax and lacked the urgency that I suspect would have been there if she was indeed down with pneumonia," said the mother.

"Later, I took a copy of the X-Ray and went to her regular paediatrician when he returned to the country. He told me that it showed no sign of pneumonia. In effect, my daughter was admitted for something that she never had," she said, narrating the constant pricking horror that her little one had to undergo.

And this wasn't all. "When I went to settle the bill before getting my daughter discharged from the hospital, I was told to pay up an 'x' sum [the opt-in percentage of the sum required to be paid by the patient].

I, however, requested for a detailed bill, and was surprised to note that the hospital had added a sum of Dh3,500 for using an 'isolation room', which was never used."

"We'd never used it and, in fact, between the diagnosis and the 'general ward' getting ready, we spent almost two hours in a female waiting area. When I insisted that this was daylight robbery, the cashier casually asked me not to sweat as I would have had to pay just a percentage of that amount and the rest of it would be borne by my insurance provider. I was simply aghast," she said.

"When I continued to argue, he reversed that entry on the bill, in effect giving me a full '100 per cent discount' on the 'use' of the isolation ward. How can they do this? I'm sure many people who are suffering from physical pain with emotions running high don't bother checking the detailed bills and pay whatever they are being charged," she added.

Many patients accuse the hospitals of overcharging and over-diagnosing because, in a majority of cases, they are covered by insurance.

"Patients would object some tests if they had to pay out of their own pocket. But most people normally don't question if the insurance company footing the bill has approved the payment," said a German national living in Dubai.

"I was once at the cashier's counter in one of Dubai's hospitals when I happened to overhear the conversation between the cashier and a gentleman who'd come to check with the cashier if a blood test, an ultrasound and a urine tests to confirm pregnancy were covered by his insurance provider. All three were recommended by the doctor to ensure that his wife was pregnant. I'm a mother and know that only one is enough to confirm pregnancy but the gentleman went ahead with all three as the doctor suggested as his insurance fully covered for those tests," an Indian mother narrated to this website.

While these are anecdotal references and do not prove that such practice is rampant, there have been recent reports that the country's medical insurers are alarmed at the rising healthcare bill and have started analysing more such cases.

According to media reports, the Dubai Health Authority (DHA) will begin regulating services provided through health insurance in Dubai by the first quarter of this year to address the problem of insurance fraud, abuse, and cases of 'over-treatment' in the emirate.

"Sometimes people are kept for longer in a hospital or in an ICU unnecessarily so these kinds of things are daily issues that [insurance] members face and they need to be protected," Dr Haidar Saeed Al Yousuf, director of Health Funding Department at DHA, has been quoted as saying.

With the framework in place, DHA will require healthcare providers to publish a price list for all their services. Increasing or decreasing prices for services will require DHA's prior approval.

"We will not set prices but we will require service providers to actually publish their prices so that if you are a hospital or a clinic, you cannot have an ambiguous price list that varies with the customer," Dr. Al Yousuf said last month.

Late last month, national insurance company Daman unveiled a new service which will ensure patients will be written prescriptions that will cure, not harm.

The service, called Pharmacy Benefits Management (PBM), will ensure that every drug dispensed by prescription will be cross-checked with rules set by the health authority and insurance companies.

These rules include making sure that the drug fits the diagnosis, that there will be no negative interactions with other prescribed medication and that the patient receives the drug at the correct time.

In fact, Daman, the government-backed insurance company, recently said that it has expanded its investigations unit responsible for spotting rogue claims.

According to reports, Daman investigates more than 1,000 cases of suspected fraud and abuse every year and last year referred several cases to the courts.

At the end of the day, some cases of insurance fraud may still go undetected as long as unethical medical practitioners continue to pry on human emotions and relatives' fear for their loved ones.

(Home page image courtesy Shutterstock)


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