Plan to cut health fraud

Hopes held for data sharing to uncover medical claims that defraud insurers.

The Dubai Health Authority is taking steps to prevent abuse of medical insurance. Jaime Puebla / The National
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DUBAI // A new data-sharing scheme should help to cut health insurance fraud, officials at Dubai Health Authority said.

Medical professionals will be given secure log-in credentials to access electronic health records – enabling the authority to track the source of breaches.

“We will be able to see who is ‘doctor shopping’ and who is doing unnecessary MRI scans,” said Dr Mohammad Al Redha, director of Health Data and Information Analysis at the DHA. “This model will save a lot of money.”

Each complaint of fraud is fully investigated. Penalties can vary, from a notice letter to a licence being revoked or a facility being closed.

It was essential to have in place a mechanism that monitored the claim process and was able to detect irregularities in suspicious cases, said Dr Ramadan Al Blooshi, chief executive at Dubai Healthcare City.

“Each patient is registered in the system with proof of identity, such as Emirates ID, driver’s licence or passport to ensure the insurance card is used only by the authorised person.”

Alisha Moopen, executive director of Aster Hospitals and Clinics, said patients in the UAE were still understanding where and how they could make best use of the benefits of health insurance, so it was still a learning curve for many.

“In my opinion, it is not always fair to call it an abuse of the system. There is a tendency for doctors to do everything they can for the patient to cover all necessary checks, before progressing to the next level of treatment.”

By June 30, all businesses with fewer than 100 employees, their spouses, dependents and domestic workers will join Dubai’s compulsory health insurance scheme.

In 2006, 8 per cent of Abu Dhabi residents were insured by 950 healthcare providers. Now, 98 per cent of the population has insurance and there are more than 1,250 healthcare providers.

In 2013, Booz Allen Hamilton Consultancy estimated that the UAE was losing more than Dh3.67 billion to health insurance fraud.

Insurers Daman said in 2014 that 70 per cent of premiums contributed to outpatient expenses and more than half of those cases did not require intervention by a physician. Its data showed 90 per cent of cold and flu cases did not require antibiotics.

* This story has been amended since it was first published.