Health insurance system being abused by unscrupulous dentists, insiders say

An oversupply of dentists in the UAE means it is a competitive market where operating in grey areas is the only way for some clinics to survive, industry insiders claim.

ABU DHABI // Many dentists are offering expensive treatment plans that their patients do not need, in fraud that is pushing up the cost of health cover, insurers say.

They say abuse of insurance is systematic and all too common in dentistry, with some practitioners obtaining approval for procedures that are covered, such as fillings, but using the money to pay for cosmetic treatments that are not.

“This is common in dentistry, with unnecessary replacement of fillings, for example, for cosmetic reasons,” said Mark Adams, chief executive of Anglo Arabian Healthcare.

One of the most common tactics to take advantage of the system is planning treatment in advance, said Dr Sherif Mahmoud, regional head of health insurance at AXA Gulf.

Using money from approved treatment for cosmetic procedures was a win-win situation for the dentist and patient, but it will drive up the cost of insurance as insurers pay out more.

“There is no guarantee the insured would continue treatment until the end of the plan,” Dr Mahmoud said.

An oversupply of dentists has led to enormous competition, and some clinics fear they will not survive unless they cheat the system, insiders claim.

Dr Benjamin Samuel, a dentist at Medeor 24x7 Hospital in Dubai who has been in the UAE for eight years, said he was aware of such dubious practices.

“I’ve worked with many dentists here and I’ve heard that this goes on but not from immediate colleagues,” Dr Samuel said. “It is harder to get away with now because there are more internal and external audits from insurance companies, so it is risky to play around with insurance but I’ve heard that this has been going on.

“We are at saturation point as there are so many dentists in Dubai from all over the world. The prices are high and most insurance policies won’t fully cover all dental procedures.

“People don’t want to spend money from their own pocket on dental work, so they do unscrupulous things instead.”

Mr Adams said: “In Dubai there are 2,500 healthcare facilities and a new one is licensed every 36 hours. There is pressure to sustain revenue.”

Penalties for dentists found to be cheating the system on the treatments they provide include recovery of costs, black listing and reporting to regulators.

It is the latest area of healthcare to come under scrutiny after claims that billions of dirhams are wasted through over-testing and use of branded medications rather than generics.

Experts predict dental insurance premiums will rise on average by up to 10 per cent a year.

The most common cosmetic treatment is bleaching, then veneers and braces. Whitening products used by most major clinics cost about Dh2,000. Veneers can cost from Dh900 and braces about Dh8,000.

In September the President, Sheikh Khalifa, announced a decree on medical liability to curb profit-hungry practitioners, including dentists.

The move was aimed at stopping healthcare costs from rising out of control.

Under the decree, professionals must “provide patients with necessary care without using their need to achieve illicit or illegal profit”.

UAE insurers often rely on honest record-keeping by dentists and misuse can be left for auditors to find when reviewing clinic files.

Direct settlement of payments could also be contributing to fraudulent cases, Dr Mahmoud said. “It might encourage some practitioners to overuse the system, being purely motivated by commercial drive,” he said.

Cosmetic procedures now form a major percentage of dentistry in the UAE. Although information about the total amount of money spent is not available, plastic surgery is a growing industry worldwide.

In the UK, cosmetic treatments have risen by 37 per cent since 2012 and are worth £2.4 billion (Dh11.2bn) this year, according to market researcher Mintel.

In August, Dr Rocco Arzoumanian, a dentist with his own practice,said fixing procedures botched by dentists formed a large part of his work.

Anglo Arabian Healthcare says spending on health in the UAE is about Dh4,408 a person a year, putting the country in the top 20 globally for per-capita expenditure.