More than 1,000 suspicious cases investigated; approximately 500 medical providers audited in 2011
Abu Dhabi, 12 February 2012: The National Health Insurance Company- Daman today announced the referral of a number of cases to the Criminal Court of Abu Dhabi on reasonable suspicion of fraud. The legal action is part of a series of measures launched by the company in 2011 to curb medical insurance fraud and abuse, shielding its 2.1 million members from damages caused by professional misconduct on the part of healthcare providers.
The fraudulent cases that were referred to the Criminal Court includes violations pertaining to claims for unperformed and medical services, duplication of invoices, documents and prescription forgery, and identity fraud.
Healthcare providers found to be committing fraud are immediately reported to the Health Authority - Abu Dhabi and later referred to the courts for further action.
Dr. Michael Bitzer, Daman's Chief Executive Officer, said: "Fraud and abuse in medical insurance poses a risk to our members' health and leads to financial losses, not just for the insurer but for the members in the form of inflated claims on their policies. Daman maintains zero tolerance for such violations and is taking every measure to limit the damage from fraud and abuse of health insurance."
In 2011, Daman introduced a rigorous auditing protocol and prudent investigation procedures to support its medical auditors and investigators in detecting cases of potential fraud and abuse. The company also increased the number of professionals serving on its medical audit and investigation team to 25 professionals with medical backgrounds. The team in 2011 investigated over 1,000 cases and audited over 500 medical service providers, including hospitals, clinics and pharmacies. The auditors routinely conduct a trend analysis of medical service providers for indication on potential cases of abuse or fraud. Daman also instituted a new fraud and abuse legal advisory team that works closely with government authorities on these cases.
"Medical investigation has been a priority for Daman from the time of its inception. Stated Dr. Jad Aoun, Chief Medical Officer at Daman. "We have planned a number of initiatives for 2012 to support this function, and are confident of further reducing instances of fraudulent claims and losses incurred from such professional misconduct"
Added measures to reduce instances of fraud and abuse include the introduction of a revised set of stringent guidelines and bolstering the medical investigation and audit team with further resources.
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About National Health Insurance Company - Daman
The National Health Insurance Company - Daman, was established on 01 May 2006. Today it is the region's leading health insurance company, providing comprehensive healthcare solutions to around 2,100,000 customers in the UAE via the largest network of private hospitals and pharmacies available.
Daman offers international standard healthcare insurance cover for both individuals and companies. A 24-hour dedicated Medical Authorizations unit, staffed by a team of doctors and nurses, ensures that provider enquiries are dealt with speedily and efficiently using the most sophisticated technology available. A second customer hotline, also open 24/7 and manned by multilingual staff, guarantees that UAE residents can access information about plans and their insurance cover whenever and wherever they want.
With an international network, Daman's members/cardholders have access to healthcare provision in 47 countries across the world depending on the terms of their personal cover. Daman members/cardholders also benefit from Daman's exclusive partnerships with Assist America, the international emergency programme. For more information, please visit: www.damanhealth.ae.
For more information, please contact:
Abdulaziz Almusalam
PR and Communication Officer
National Health Insurance Company - Daman
abdulaziz.almusalam@damanhealth.ae
Tel: +971 56 616 3254
Nitin Nambiar
Senior Account Manager
ASDA'A Burson-Marsteller
n.nambiar@asdaa.com
Tel: +971 2 633 4133
Kate Shaughnessy
Account Manager
ASDA'A Burson-Marsteller
k.shaughnessy@asdaa.com
Tel: + 971 4 450 7600
© Press Release 2012
