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INSURANCE LAW VIOLATIONS

Dr Haidar Al Yousef

DHA imposes hefty fines on 25 health facilities

DUBAI, April 11, 2017

The Dubai Health Authority (DHA) has imposed fines on 25 health centres, clinics, insurance brokers and insurance companies for violating the Dubai mandatory health Insurance law, while it has referred six clinics to prosecution for potential fraudulent activities.

The DHA revealed the violations were found during surprise and routine inspections conducted by the authority’s Health Funding Department as well as from member complaints, said a statement.
 
Dr Haidar Al Yousef, director of the Health Funding Department at DHA, said the fines imposed on these health centres, clinics, insurance brokers and insurance companies ranged from Dh10,000 ($2,722) to Dh80,000 ($21,780).

“Some healthcare providers and insurers didn’t comply completely with the Health Insurance Law and the circulars issued by the health funding department. We observed is through inspection visits, compliance meetings as well complaints received from different parties involved in the system. Therefore we have resorted to fining them to avoid such acts in the future,” he said.

Dr Al Yousef revealed that the violations include but are not limited to: Healthcare provider altering the diagnosis to get claims paid; Healthcare provider submitting claims for non-performed services; Healthcare provider submitting partial case details to get coverage and get claims settled; Beneficiary abusing the health insurance card; Ordering unnecessary services and tests; Healthcare provider submitting invoices and getting payment before even the services done to the members in which in most of the cases the patients don’t come back to complete the services such as dental and physiotherapy sessions; Delay by insurance companies in issuing the health insurance cards or activation of the emirates ID; Non-compliance by the insurance companies with the customer satisfaction level required by the DHA especially the front desk and employees handling call centre; Insurers marketing or advertising wrong information without verification from DHA; Insurer practising health insurance in Dubai market without DHA/HFD license; Insurer dealing with unlicensed companies practicing health insurance in Dubai market without DHA/HFD license.

Dr Al Yousef said that violating facilities received a warning that was followed by a fine and some were even referred to prosecution and might face criminal punishment due to potential fraudulent activities.
 
Employers and sponsors who fail to provide mandatory health insurance cover are now liable to a fine of Dh500 per month. Apart from the fine, no new visa will be granted and no existing visas renewed without health insurance, according to DHA.  - TradeArabia News Service




Tags: Insurance | DHA | Dubai Health |

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