Investigation. An investigation conducted by UIA found that health
service providers had been involved in inflating bills and offering
services to none-members. FILE PHOTO
Insurance companies have terminated services of at least 30 health service providers over allegations
of fraud.
In notices issued yesterday, medical insurance service providers notified their clients that they had terminated the services of about 30 health services providers with immediate effect.
of fraud.
In notices issued yesterday, medical insurance service providers notified their clients that they had terminated the services of about 30 health services providers with immediate effect.
The
termination culminated from an investigation in which Uganda Insurers
Association (UIA) found that some health services providers were engaged
in fraud.
Mr Paul Kavuma, the UIA chairman declined
to comment on the matter referring Daily Monitor to an earlier statement
in which Uganda Regulatory Authority said there had been an increase in
fraudulent insurance claims.
However, no details of
the alleged fraud were provided and it remains unclear whether UIA will
seek further sanctions against the companies.
Ms
Mariam Nalunkuuma, the Insurance Regulatory Authority senior
communications manager, yesterday said the termination was a step in the
right direction towards combatting fraud in the insurance sector.
“IRA
does not regulate health service providers. What happens is insurance
companies identify them to provide treatment to their clients. If
insurance companies find problems with a health service provider, it can
decide to terminate. This has happened in the wake of fraudulent cases
reported to IRA and UIA,” she said, noting that chief executive officers
have been compelled to tighten fraud management, which has been
skyrocketing among some medical services providers.
“It is a business decision for them to terminate and IRA does
not command who they should deal with or not. What is important is to
talk to the terminated medical facilities to change,” she added.
Asked
whether IRA would charge those implicated in the fraud, Ms Nalunkuuma
said: “There is no specific law we can point to,” noting that as the
regulator, “focus is to ensure that clients are served well, get their
claims promptly and efficiently.”
The insurance sector has over time registered an increase in fraudulent claims.
According to IRA, fraudulent claims worth Shs4.9b were recorded between January and September 2019.
According to IRA, fraudulent claims worth Shs4.9b were recorded between January and September 2019.
At least Shs64m worth of fraudulent medical insurance claims were registered in the period.
The insurance companies are now raising the alarm to ensure policy holders are not cheated and are offered the right services.
The insurance companies are now raising the alarm to ensure policy holders are not cheated and are offered the right services.
Medical
insurance services providers key among them Jubilee and UAP, said
yesterday that Uganda Insurers Association had commissioned a fraud
survey of service providers and had found that a number of those that
were terminated were non-compliant.
“Although this
action may result into regrettable inconveniences, it is done in good
faith to ensure that your benefits are not robbed in the manner the
affected facilities [terminated] have been doing,” one of the notices
read in part.
Daily Monitor has omitted details of the
listed companies because none has been sanctioned before court to
answer for the alleged fraud.
The fraud
According to a source who declined to be named because he is not authorised to speak to the press, hospitals and other services providers, according to the UIA investigations, had been conniving with clients to inflate service bills.
According to a source who declined to be named because he is not authorised to speak to the press, hospitals and other services providers, according to the UIA investigations, had been conniving with clients to inflate service bills.
Other service providers, he said, had
been billing insurance firms for no service offered while others have
been dispensing services to none-card holding members.
Inflating
bills, he said, remains a major challenge in the medical insurance
sector, which calls for concerted efforts to stop the vice.
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