DUBAI // Regulators have come down hard on clinics and insurers caught violating strict new health insurance rules, with 25 facilities hit with fines and six facing prosecution for fraudulent activities.
Fines imposed on health centres, clinics, insurance brokers and insurance companies under the Dubai Health Insurance Law range from Dh10,000 to Dh80,000, after the March 31 compliance deadline passed.
Those found in breach of regulations were detected either by spot checks by Dubai Health Authority inspectors, or as a result of reported complaints.
“Violating facilities received a warning that was followed by a fine,” said Dr Haidar Al Yousef, director of the DHA health funding department.
“Some healthcare providers and insurers didn’t comply completely with the Health Insurance Law and the circulars issued by the health funding department.
“We observed this through inspection visits, compliance meetings as well as complaints received from different parties involved within the system.”
Inspectors found some healthcare provider were submitting claims for services they had not performed, while other clinics were altering the diagnosis of some patients to ensure claims were paid by the insurer.
Last year, The National reported that billions of dirhams a year was being wasted on unnecessary medical tests and procedures, prescriptions for expensive medicine and patient fraud – all paid for by health insurers.
Identity fraud by patients and a culture of over-prescribing by doctors who are often offered financial incentives to prescribe brand-name drugs were also common crimes uncovered by insurance watchdogs.
In the latest crackdown by authorities, inspectors have found some healthcare providers submitting partial case details to get coverage and claims settled.
Some have been to found to be abusing their health insurance card or ordering unnecessary services and laboratories to boost clinical profits.
Other minor offences have been insurance firms failing to comply with DHA customer satisfaction levels and call handling, or wrong information advertised without DHA verification.
Dubai Health Insurance Law came into effect in January 2014, introducing a legal liability for every sponsor to provide an essential benefits package, which costs between Dh550 and Dh750 a year.
“Apart from the fine, no new visa will be granted and no existing visas renewed without health insurance,” Dr Al Yousef added.
“Some have been referred to prosecution and might face criminal punishment due to potential fraudulent activities.”
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