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Premium Companies in KSA Are Facing Health Fraud

Premium Companies in KSA Are Facing Health FraudOn Saturday, Al-Hayat Arabic, daily newspaper, mentioned that the medical premium organizations in are losing more than SR1.2 billion a year because of the fraudulent allegations and hospitals misusing the identities of premium card holders. Hospitals “in many cases” are also offering unnecessary examinations and services to expand income from medical premium organizations.

Omar Hafidh, said to Al-Hayat, who is an insurance company executive director that a “high percentage” of facilities providing services didn’t succeed in checking personal information’s-identity card or residency permit –of premium claimants, resulting in “services being provided to persons not covered by insurance”., He put different shapes of deceit, from offering bills for medical services not provided, to change the nature or date of services and procedures rendered. The facility is from the major offices of the premium organizations.

Hafidh reported “The rate of deceit is particularly high in Saudi Arabia. Fraudulent claims constitute approximately 15 percent of their annual revenues, something which he put down to the industry being new in the Kingdom, with laws and regulations governing the sector “still in their infancy. We need to introduce more technology such as fingerprinting to check the background of the claimant, some hospitals have fingerprint checking machines to prevent cards being used by persons other than their owners.”

Fahd Al-Enizi, a premium specialist, mentioned that the most examples of fraud and deceit in the medical section were formed in complete compliance with the physician, nurse or pharmacist .He also reported “The patient might be paid money without any medical examinations being carried out or any expense made on medication. This is a defrauding of the insurance company,” Recently the Health Security Council obliged private section organizations to offer health premium for foreign resident crew in the kingdom, while some 3, 000000 Saudi nationals are predicted to join them, the council should be ruling in order to give private section Saudi officers and their families’ obligatory medical insurance come into force.

Al-Hayat mentioned with three fundamental premium companies accounting over 85% of the section that the health sector is considering the biggest premium industry in the country.

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