Blacklist fraudulent insurance clients

The news about the insurance industry is about the disturbing level of fraud that has hit the industry in recent times. First was the revelations made during the 44th Chief Executive Officer’s Conference in October, where the chief executive of the Insurance Regulatory Authority (IRA) stressed that fraud was becoming one of the monsters impeding the progress of the industry.

Then Uganda Insurers Association (UIA) commissioned a medical Insurance fraud investigation study, which revealed shocking details about the vice among some medical service providers. This led insurers to share termination notices of the implicated facilities to their clients, which went viral on social media and generating debate.
Although the survey report is the most recent document in the public domain whose findings can be used to gauge the extent of fraud in the industry, those who understand the subsector will agree that this is just one of the many unexposed fraud tendencies that the industry is grappling with. We need to appreciate UIA for facilitating the investigation that has shed light on the magnitude of the problem. We also applaud the different Insurers who have taken action against the perpetrators despite the possible inconveniences.

This sets a precedence on how the industry treats related cases as we keep preaching and practicing the zero-tolerance to fraud gospel.
Despite the various remedies that are available to insurers, including litigation under Sections 309, 342 and 346 of the Penal Code Act 1956, depending on the available evidence, this would neither be a sufficient nor sustainable path to a logical conclusion. Therefore, the final users of the insurance services may still continue to pay the price for the actions of selfish actors.

Since more than Shs44b (35 per cent) of the total claims expense and second largest proportion as of 2018 goes into payment of medical bills, it is important that IRA picks interest in monitoring the level and quality of services offered to clients in this line to ensure value for money to the customers. In fact, regulating the insurers without knowing how the actual service is given to clients pauses a big risk to the industry. Patients always blame insurance companies for poor services at health facilities.

Through partnerships and collaboration with Allied Health Professions Council and similar bodies, the insurance regulator may sensitise and also train medical service providers on the basic concepts of insurance (utmost good faith), as well as set minimum expectations, which would greatly improve the situation. This would also serve to level the ground and build capacity for the insurance industry a head of the implementation of the National Health Insurance Scheme as proposed by the Ministry of Health.

However, all the interventions may not yield much if the insurance clients, who are seen to be at the epicentre of the fraud, are left to go scot-free after committing the felony. Whether cooperate or individual clients, once found guilty of committing insurance fraud, they should be blacklisted by IRA so that they do not get insured by any insurance company in the country over an agreed period of time. This will make the cost of fraud higher and it will go a long way to eliminate the vice.
Daniel Kabire,
[email protected]