HAAD Uncovers 38 Cases of Health Insurance Fraud
(WAM)
- Khaleej Times
18 April 2010
Abu Dhabi - The Health Authority - Abu Dhabi (HAAD), the regulative body of the
Healthcare sector in the Emirate of Abu Dhabi, announced that 38 health
insurance violation cases, including suspected cases of fraud, forgery and abuse
had been uncovered during inspection visits conducted by the Audit Section of
the Health Insurance Regulation Department at HAAD.
These visits covered some healthcare providers (insurance companies/ third party
administrators and employers) in the Emirate of Abu Dhabi. A number of these
have been referred to prosecutors while 18 fines were issued as per the law.
HAAD issued fines ranging from AED 10,000 to AED 20,000 per violation to
clinics, pharmacies, and medical professionals. Violations included claiming for
medical services not provided to patients, replacement of prescription
medications with non prescribed drugs, medical and non medical consumables, and
non medical items. A further violation included employers and/or sponsors not
providing continuous health insurance coverage to their sponsored employees who
are working and/or residing in the Emirate.
HAAD also referred certain violations to the Abu Dhabi misdemeanor court, which
issued a decision to fine Dr. B.K. in M.D. clinic the amount of AED 10000 for
receiving the value of treatment services that were not provided to the patient
and forging documents. The court also sentenced two defendants for a period of
two months imprisonment followed by deportation from the country for the
issuance of forged health insurance cards. The court also ordered destruction of
the forged cards as a result of their fraudulent acts against insurance
companies in order to issue health insurance cards based on forged documents.
Company I.A.I. were fined AED 90,000 and company M.N were fined AED 70,000 by
HAAD for underwriting health insurance policies which cover less medical
services than is mandatory under the policies, non-compliance with health
insurance policies, non-compliance with the policies terms and conditions, For
non-adherence with health insurance basic product rates approved by HAAD, making
changes to these health insurance policies, providing false and misleading
information when applying for a license, and for non-compliance with the rules &
principles in marketing health insurance policies.
HE Engineer Zaid Al Siksek, CEO of HAAD, said: ‘Access to high quality health
services is the right of every resident in the Emirate of Abu Dhabi. Inspection
visits are conducted to ensure the commitment of all concerned parties to health
insurance law, and that companies and individuals are protected from fraudulent
and abusive behavior.’
HAAD also decided not to renew the license of a Third Party Administrator M. N.
due to repetitive irregularities & violations such as working in areas beyond
the granted license, the existence of conflict of interest between the company
and providers of health care services and violation of undertaking made by the
company when applied for license and practicing activities not licensed for in
the field of Health Insurance Scheme.
HAAD has called upon all customers to provide their comments or complaints in
the event of suspected cases of fraud or misuse by calling HAAD’s Customer
Service Centre toll-free number, 800800 or by emailing HAAD on:
healthcare@haad.ae