HAAD Announces Health Insurance Cases of Fraud And Abuse 1>

The Health Authority – Abu Dhabi (HAAD) 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.

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.

In addition, HAAD 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. was 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.

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.

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