The National Health Insurance Company - Daman, the leading health insurance company in the region, has confirmed that it has further discovered suspicious fraud and/or abuse cases and has taken necessary action.
Some of the suspicious fraudulent cases discovered; included two committed by dental clinics in the UAE. Through the frequent medical review of provider invoices and cases conducted, Daman’s Medical Audit Department found that one provider overcharged Daman for services rendered to its members. The provider used incorrect codes when invoicing Daman for services that were conducted.
Another provider was found to be invoicing Daman using false information of its patients and/or service charges. Some of the alleged cases detected included the provider claiming for services of non-existent patients; while other cases included claiming for more services than what was actually conducted.
This was immediately detected by Daman while conducting a regular review of patients’ files against actual invoices. In some instances concerned patients were contacted to verify and confirm whether these services had been rendered by the provider or not.
The Chairman of Daman, Mr. Khaled Abdulla Al Qubaisi said: “Immediate action was taken against these dental clinics once the cases were discovered. They were immediately suspended from operating within Daman’s network of healthcare providers and forced to repay the embezzled amount in full. Additionally, the providers are currently being reported to the Health Authority - Abu Dhabi (“HAAD”) and the concerned legal authorities.”
He continued, “Daman’s Medical Audit Department employs trained and experienced professionals who are constantly working on detecting and preventing abuse to ensure the highest level of services. It constantly carries out regular reviews of claim forms and patients’ files, and dispatches mystery shoppers in a pre-emptive method to combat fraud and abuse within the healthcare system. ” He added; “Under no circumstance will any form of abuse or fraud be tolerated by Daman. Any provider found to be committing any form of abuse or fraud will be dealt with immediately through all necessary legal actions.”
Dr. Michael Bitzer, Chief Executive Officer of Daman commented: “Daman’s members and clients play an important role in deterring abuse. Fraudulent or abusive claims that go undetected will not only affect the society at large, but will also affect the underwriting process and ultimately result in unfairly increased premiums for customers; therefore it is essential that members actively report any inaccurate or fraudulent cases.” He added, “With Daman’s strict policies and procedures, Daman will not tolerate any forms of fraud and abuse and will continue in its efforts to protect its customers and society.”
Earlier in the year, Daman introduced a dedicated extension to its existing Toll Free number 800 4 Daman (32626); for members and clients to report any cases of suspected abuse. This is in-line with its strategy to combat all forms of fraud and abuse to protect its customers and for the betterment of the society as a whole.
To report abuse please contact Daman’s Toll Free number 800 4 Daman (32626) or logon to www.damanhealth.ae
