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RIYADH — Identity thefts and other fraudulent practices are the main reasons for heavy losses suffered by health insurance companies.
This has resulted in insurance companies rejecting about 25 percent of claims by hospitals and other service providers, said Maher Al-Joairy, an insurance expert.
“Most of these fraudulent practices are committed by patients and service providers themselves,” Al-Joairy said while speaking to Al-Riyadh Arabic daily.
“Increased foul play in using health insurance cards has prompted insurance firms to reject 25 percent of claims,” he added.
He attributed the growing number of foul play to weak performance of insurance companies and weak supervision. He proposed affixing of photographs of the insured individuals on insurance cards in order to prevent misuse and foul play and reduce losses to insurance firms.
“Some service providers do not have fingerprinting system to prevent foul play,” he pointed out.
Al-Joairy accused some hospitals of foul play, saying this has increased the cost of insurance companies as well as insurance claims. Some other hospitals present fake bills to insurance companies in order to receive more money than they deserve.
He called for opening up the Kingdom’s health insurance market to foreign companies to promote fair competition and improve services. “We should also set out new laws to protect the rights of investors and private hospitals as well as the rights of insured individuals,” he said.
Al-Joairy commended business centers at government hospitals for playing an excellent role in improving health services and said it could affect the business of private hospitals.
He emphasized that insurance firms in the Kingdom have been incurring heavy losses as a result of foul play.
“Insurance companies are now thinking of how to avoid losses instead of making profits as a result of the fraudulent practices in the sector,” he pointed out.
“We can see this clearly when we go through financial statements of these companies,” Al-Joairy said and urged the authorities to support the insurance sector to strengthen national economy.
© The Saudi Gazette 2017
