The Kingdom’s medical insurance companies are losing up to SR1.2 billion a year due to fraudulent claims and hospitals misusing the identities of insurance card holders, Al-Hayat Arabic daily reported Saturday.
Medical facilities are also reported as providing unnecessary examinations and services “in many cases” in order to increase income from medical insurance companies.
Omar Hafidh, an insurance company executive director, told Al-Hayat that a “high percentage” of facilities offering services fail to properly check personal data – identity card or residency permit – of insurance claimants, resulting in “services being provided to persons not covered by insurance”.
Hafidh cited various forms of deceit, from presenting bills for medical services not provided, to altering the nature or date of services and procedures rendered.
Rates of deception are also observed to increase proportionally further the distance the facility is from the main offices of the insurance companies.
“The rate of deceit is particularly high in Saudi Arabia.
Fraudulent claims constitute approximately 15 percent of their annual revenues,” he said, 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,” Hafidh said. “Some hospitals have fingerprint checking machines to prevent cards being used by persons other than their owners.”
Insurance specialist Fahd Al-Enizi said that most examples of fraud and deceit in the health sector were carried out in full compliance with the doctor, nurse or pharmacist.
“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,” he said.
The Health Security Council recently obliged private sector companies to provide health insurance for foreign resident staff in the Kingdom, while some three million Saudi nationals are expected to join them should the Council ruling to grant private sector Saudi employees and their families compulsory health insurance come into effect.
The health sector represents the largest insurance industry in the country, Al-Hayat said, with three main insurance firms accounting for over 85 percent of the sector.
Saudi Gazette