Health insurance fraud in the UAE is on the rise
Health insurance fraud in the UAE is causing financial losses for the insurers, and higher premiums for customers. There are multiple complications associated with growing health insurance fraud in the UAE: rising insurance premiums, sure, but other new trends are evolving that insurers are taking notice of. In response, insurers are delaying approvals of costly operations for patients, or even searching for cheaper overseas options, making patients wait longer for critical treatments. In today’s article, insurance experts from Pacific Prime Dubai will provide information on what insurance fraud is, and what it means to you.
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Common types of health insurance fraud in the UAE
Let’s start with what health insurance fraud is. Health insurance fraud occurs when someone intentionally lies to gain a profit or advantage to which they are not otherwise entitled. Health insurance fraud can be perpetrated by healthcare providers, insurance policyholders, or even insurers themselves.
While there are many ways to cheat the system, there are a few common types of health insurance fraud in the UAE that stand out:
Billing for more expensive treatments than required: A doctor is exaggerating a diagnosis to a more serious condition in order to increase the value of a claim.
Prescribing expensive, branded medication: Doctors are over-prescribing certain medications, as they receive financial incentives to prescribe brand-name drugs.
Falsifying diagnosis: A doctor is falsifying a patient’s diagnosis to charge for and perform procedures that are not medically necessary. This may include ordering unnecessary laboratory tests for a healthy patient.
Billing for services not performed: This type of health insurance claim is self-explanatory. A healthcare provider may add procedures and services to a patient’s claim that did not take place.
Misrepresenting non-essential treatments: The act of claiming for non-essential procedures by representing it as a medically necessary treatment.
Procedures for pay: This is the act of performing procedures on healthy patients solely for the purpose of making insurance claims.
Upfront pay: A healthcare provider submits invoices and gets payment for ongoing treatments, such as dental or physiotherapy sessions. Even if patients don’t show up, the healthcare provider is paid, whether the service was performed or not.
Abuse of health insurance card by the beneficiary: A beneficiary misrepresents personal information such as identity, eligibility, or medical conditions to receive a health benefit illegally.
The types of medical insurance fraud mentioned above are only some of the many forms that occur everyday.
Insurance premiums are expected to rise
Abuse of health services in the UAE costs 10-15% of total collected premiums, according to MEIR. With health insurance premiums reaching AED 19.4bn (USD 5.3bn) in the UAE, 15% would equal AED 2.9bn.
With this information in mind, insurers will more likely increase each year’s premiums to compensate for their losses, as predicted in Pacific Prime’s 2018 Cost of Health Insurance report. Insurance fraud, among other factors such as increased demand for international quality private care and new regulations, is the main cause behind rising health insurance premiums in the UAE and worldwide. Why, then, does medical fraud continue in the UAE?
The “use it all” culture
Quite often hospitals are encouraging patients to take extra, not medically necessary, treatments, stating that their insurance policies cover them, so there is no financial harm on the patient’s side. This may occur, perhaps, due to the fact that private hospitals in the UAE are revenue driven, and practitioners often have certain quotas to meet.
Another side of this culture is that UAE residents are used to having comprehensive insurance. Thus, they often seek a second opinion regarding their condition, making double or even triple appointments to discuss the same matter.
Effects of health insurance fraud on policyholders
It may seem that taking on additional treatments or asking for sick leave with a fake illness is harmless, as it doesn’t directly hurt anyone. However, the consequences of such actions bounce back to patients and care providers in the long run. Besides the higher premiums that honest patients have to pay, there are other adverse effects of health insurance fraud in the UAE.
Insurance frauds pose threats to providers’ ability to deal with genuine claims promptly. Insurance companies need to prove the authenticity of the claim, and often seek a second doctor’s opinion or even look for a cheaper alternative abroad before agreeing to pay out for expensive procedures. That approach leads to delays in sometimes critical treatments for honest patients. Sometimes patients who cannot wait months for an insurer’s decision end up paying out of pocket for the treatment.
On the other side of the scale are the medically unnecessary treatments prescribed by the doctors to healthy individuals, which may cause a physical risk to patients.
Last, but not least, the problem of medical identity theft is real. When a person’s personal information is used without that person’s knowledge to obtain medical services, obtain goods, or submit false insurance claims, it’s medical identity theft. Medical identity theft victims may receive the wrong treatment, find out that their health insurance benefits have been exhausted, or become banned from future coverage by an insurer.
How can you fight health insurance fraud in the UAE?
Your best chance for a premium increase that won’t destroy your budget is to help fight medical fraud. If you notice that you are given treatments that don’t relate to your condition, or only see a prescription for expensive, branded medications, report it.
You can either contact your insurance company directly, or contact your broker to help you notify them. In fact, insurance brokers such as Pacific Prime Dubai offer a wide range of services that can help you with handling claims, and even advise you on the right hospital and clinics to undergo your prescribed treatments. The experienced claims team at Pacific Prime Dubai can spot any irregularities, and report them to insurers before any fraudulent claims can harm your ability to continue coverage with your insurer.
If you are left with any questions about UAE or Dubai health insurance, feel free to contact us at any time! Our insurance advisers are here to consult with you on any and all insurance matters.
When she isn’t writing, you are most likely to find Elwira in search of the perfect plant-based burger or enjoying Hong Kong’s great outdoors either at the beach or from the boat - the closer to the sea, the better!
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