Hospitals on spot over alleged health insurance fraud

A number of hospitals and health centres could be stopped from serving clients who have health insurance policies after insurance companies accused them of fraud.

This comes after the Uganda Insurers Association (UIA) commissioned a fraud survey in 2018/19 financial year that found a wide-spread scam where hospitals submit fictitious claims and bills to insurance companies for clearance.

Ms Faith Ekudu, the spokesperson of UIA said they would let service providers (insurance companies) determine actions to be taken against cheating hospitals.

 In a 1 November letter, Jubilee Insurance notified its customers (those who hold Jubilee medical insurance cards) that is was terminating services of 23 hospitals in Kampala and surrounding areas.

Jubilee Insurance said that “although this action may result into some regrettable inconveniences, it is done in good faith to ensure your beneficiaries are not robbed in the manner the affected facilities have been doing.”

UIA says while fraud affects all business lines in the insurance sector, it has been increasingly prevalent in the medical class of business.

The fraud is done in various ways; including collusion between the medical policy holders and health service providers, inflated bills from hospitals and clinics, hospitals making patients take unnecessary tests, impersonation or dual membership by policy holders and pharmacy related fraud.

In the same vein, some hospitals were found to apply two tier pricing for their services.

This happens when patients who present medical insurance cards are charged more than those who pay cash for the same service.

According to the 2018 Insurance Regulatory Authority (IRA) report, medical insurance uptake is one of the fast-paced segment of insurance in Uganda – now the largest class of business by corporate institutions.

Medical insurance gross written premium grew by 26.96 percent from Shs 161 billion in 2017 to Shs 204.05 billion in 2018.

With this growth, fraud has also increased.

Last year, IRA and the UIA set up an anti-fraud unit to investigate fraudulent cases in the industry.

At least 17 cases worth Shs2.5billion were investigated.

Dr Isaac Nkote Nabeta, the IRA board chairman said this indicates the need for insurers to tread judiciously to remain afloat without jeopardising the interests of the policy holders.