Daman unearths fraudulent practices - Gulf News

Published: May 17, 2009, 00:04
 

Abu Dhabi: The National Health Insurance Company, Daman, has unveiled a number of fraudulent practices at some healthcare institutions. Daman's Medical Audit Department employed and dispatched a team of 'mystery shoppers' to a number of healthcare providers.

Daman revealed that one provider filed false information with respect to the patients' symptoms, medical history and diagnoses as well as claiming for excessive tests and treatments that were not conducted.

Dr Michael Bitzer, Daman's Chief Executive Officer, commented: "It is our duty to protect our customers' best interest; fraudulent claims that go undetected will affect the underwriting process and ultimately result in unfairly increased premiums for customers."


Dr Rainer Petzel, head of the legal department at Daman said, "Health insurance fraud occurs across the world; through our Medical Audit Unit we are attempting to control and minimise the levels of fraud and abuse within the UAE".

Daman has also uncovered a number of fraudulent cases where pharmacies have switched prescriptions based on patient requests and dispensed alternative products and cosmetics that are not covered by their insurance plans.

Depending on the severity of the case, violating providers were either issued warning letters stating that the matter would be referred to Health Authority - Abu Dhabi (HAAD) and/or frozen from operating within Daman's healthcare providers' network.

Daman has established an ethical framework and operational criteria that healthcare providers must adhere to in order to be contracted into Daman's network.