Medical Council speaks out on health insurance fraud

Friday November 8 2019

Treatment. Dr Joshua Musinguzi of Mulago

Treatment. Dr Joshua Musinguzi of Mulago National Referral Hospital attends to a patient in November 27, 2017. Health sector practitioners have condemned alleged health insurance fraud. Photo Stephen Wandera 


The regulatory body responsible for overseeing operations of health facilities in the country has condemned the alleged health insurance fraud.
Dr Katumba Sentongo, the registrar of Uganda Medical and Dental Practitioners Council (UMDPC), said although they have seen the report, it is not addressed to them and neither have they received an official complaint.
“When it comes to us, we shall decide on what to do because the way we work we have to first receive a complaint, otherwise, it is a very bad practice,” Dr Katumba said yesterday.

The Uganda Insurers Association (UIA) commissioned a fraud survey in the 2018/2019 Financial Year that found wide-spread scam where hospitals submit fictitious claims and bills to insurance companies for clearance.
As such, some insurance companies such as Jubilee notified their customers that it was terminating services of 23 hospitals and surrounding areas despite the inconveniences.

Ms Mariam Nalunkuuma, the Insurance Regulatory Authority (IRA) senior communications manager, said they had been receiving complaints from insurance companies when they advised them to make stringent policies.
“This year alone, we received complaints of fraud cases worth Shs4.9 billion and last year it was Shs3b,” Ms Nalunkuuma said.
Ms Nalunkuuma also stated that since it was a business decision to conduct the investigation, it is up to the medical facilities to engage the insurance companies so as to continue serving the people
According to some sources within insurance companies who spoke to the Daily Monitor on condition of anonymity, the hospitals and other service providers were, among others, conniving with clients to inflate medical bills.

Others were billing insurance firms for no service offered while others were dispensing services to non-card holding members.
Mr Indren Poovan, the chief executive officer of the AAR clinics, which was among those named in the scandal, refused to comment on the matter saying they were still engaging various insurance companies about their findings.
“Please be advised that we cannot comment on this matter as yet as we are still waiting for the various insurance companies to provide the details of their findings,” Mr Poovan responded in an email.
UIA says while fraud affects all business lines in the insurance sector, it has been increasingly prevalent in the medical class of business.

Some affected facilities

• International Medical Centre –All branches
• AAR Health Services –All branches
• Bugolobi Medical Centre
• Doctors Medical Centre
• Sarec Medical Centre
• Byansi Clinic
• Mayanja Memorial , Mbarara
• Marie Stopes –All branches
• Ntinda Family Doctors
• Kampala Hospital
• True Vine Hospital
• Vine Pharmacies-All branches
• UMC Victoria Hospitals
• Lira Medical Center Kampala Medical
• Bethany Women’s Hospital
• Alpine Medical Centre
• Ageteraine Nursing Home
• Eco Pharmacy