Insurance fraud: Hospitals, companies enter dialogue
Jubilee Insurance Company is one of the insurance companies that suspended several health service providers over fraud
Private health facilities accused of defrauding insurance companies have entered into a dialogue with the latter aimed at reinstating the contractual relationship.
The development comes after the Uganda Insurers Association (UIA) commissioned a survey in Financial Year 2018/19 that found widespread scam where hospitals submit fictitious claims and bills to insurance companies for clearance. This forced some insurance companies to terminate contracts with the hospitals.
Ms Grace Kiwanuka, the executive director of Uganda Health Care Federation (UHCF), said the hospitals are not intentionally defrauding the insurance firms but attributed it to ignorance about the insurance policy.
“The provider may say ‘if you want a drug that is not on your prescription, I will add it’. So it does not mean your philosophy as a company is to defraud insurance. There is a lot of ignorance or misunderstanding of someone serving the client and to me, this is an opportunity of highlighting how insurance works,” Ms Kiwanuka said.
She was speaking at the Private Health Sector Convention in Kampala last week. Ms Kiwanuka added that they are currently holding talks with both UIA and services providers, who are UHCF members, to see how they can understand the issue from each other’s perspective.
“They [insurers and hospitals] all want to talk, so we have agreed that at this point, individual providers, who are affected engage with the health insurance to figure out exactly where the challenge is. You can’t treat a problem until you have understood what it is,” Ms Kiwanuka stated.
At the same event, the commissioner for the Department of Health Sector Partners and Multi-Sectoral Coordination at the Ministry of Health, revealed that together with the ministry of Finance are working to establish a $10m (about Shs37b) medical credit fund for the private health investors in the country.
“Private health care providers can use it to invest in the system like the purchase of MRI machines, CT scans and other specialised services. They scale up their services and increase accessibility. Part of that money comes from the government and then another part comes from the World Bank,” Dr Aliti said.
He said the proposal will be taken to Parliament for approval before the end of the financial year.
Private healthcare providers in attendance decried the challenges of accessing credit from financial institutions yet the equipment they use is very expensive.
