Undercover patients to expose fraud

The Dubai Health Authority will employ a team of 'mystery shoppers' to expose cases of insurance fraud among hospitals and clinics.

The Dubai Health Authority (DHA) has dispatched a team of 'mystery shoppers' to expose cases of insurance fraud among hospitals and clinics. The authority reported today "a number" of cases of what it called "abuse and fraud" among a network of health providers operating under the ENAYA insurance programme, which serves about 100,000 Government of Dubai employees and their families. In one case, a physician tried to convince a 'mystery shopper' posing as a patient that he should have surgery that was not covered under ENAYA. The physician falsified the patient's symptoms and medical history, and fraudulently gave a false diagnosis. He then carried out expensive pre-operation checks, despite knowing that the full operation could not be approved by ENAYA. "Health insurance abuse and fraud is a common problem internationally, and our department's role is to keep strict supervision to prevent and minimise the occurrence of such incidents," said Dr Haidar Al Yousuf, the director of the Funding Department at DHA. Once the DHA uncovers a case of fraud, it issues a warning letter, and can remove the health facility from the ENAYA network and take legal action. However, patients also make fraudulent claims, Dr. Haidar said. He warned of "serious health risks" if patients pretend to need certain medicines then give those to other people, such as relatives. Having false medical information may cause the healthcare provider to reach a wrong or an inaccurate diagnosis, or to give wrong treatment, he said. [e-mail]