How your doctor gets kickbacks for prescriptions

Doctors often over-prescribe medicines or subject patients to unwanted medical procedures to line their pockets

  • Unethical: Many private hospitals and clinics continue to 'incentivise' doctors compelling them to genImage Credit: supplied
  • Widespread: Insurance companies say the practice of giving commissions to doctors is rampant in the private seImage Credit: supplied
22 XPRESS

Abu Dhabi: Patients are being grossly over-billed and subjected to unwanted medical procedures and tests as doctors try to generate higher revenues for hospitals and clinics in order to earn higher commissions, XPRESS can reveal.

Industry sources say the unethical practice is rife in the UAE with doctors taking anything between 25 and 50 per cent cuts from the total revenue they generate for hospitals through consultation and medical procedures, including surgeries.

A source at a private hospital in Abu Dhabi says general practitioners receive 20 to 30 per cent commission on lab tests they prescribe. “We have files here that indicate a large percentage of patients who consult our general practitioners for common cold or sore throat are subjected to tests for tonsillitis. Lab tests and CTC scan are routine, even if unnecessary,” said the source requesting anonymity.

Insurance companies say millions of dirhams have been claimed in excess by hospitals.

Andre Daoud, chief business officer of NEXtCARE (third-party administrator handling 82 insurance companies), told XPRESS that some private health care providers have the tendency to offer financial incentives in order to attract and retain talented and experienced medical professionals; however, he questioned how balanced this could be and whether it aligns with patient satisfaction and social responsibility.

He said incentives should be based on quality of care which can be measured through patient surveys and feedback channels.

“If incentives are quality-based and not driven by revenue generation, they will have a positive long-term impact on the quality of health care offered in private hospitals,” said Daoud.

An official from Arab Orient Insurance Company said there is a sharp rise in insurance claims by hospitals, but not many people are willing to disclose it. “Overbilling a patient cannot be easily contested as it is the professional discretion of the treating doctor as to what medicines and tests are to be prescribed,” the official said.

A recently conducted independent survey by Dr Ayham Refaat, founder of medical billing solutions consultant Accumed PM, said 598,000 medical insurance claims worth Dh263 million were filed by 10 private hospitals in Dubai and Abu Dhabi (between 2011 and 2012) of which Dh20.6 million was disputed.

The survey also exposed irregularities and inconsistencies in the diagnostic tests prescribed by various doctors for ailments like diabetes, hypertension, anaemia, thyroid disorders and Vitamin D deficiency.

doctors in defence

However, doctors who spoke to XPRESS said ‘incentivisation’ is not wrong as long as ethics of the profession are not violated.

A practicing orthopedist in Dubai said he does not generally over-prescribe, but gets a commission from the medical clinic he works for. “I have a loyal base of patients. They trust me and I am committed to offering them quality care. So where is the question of corruption?” asked the Indian doctor who said he gets a monthly salary of Dh15,000.

“Definitely the incentives I get forms the bigger part of my income,” he said, without mentioning the exact amount he receives in commission.

When asked whether it is ethical to take commissions and overbill patients, an Indian doctor said it is ‘okay’ to overprescribe medicines as long as patients are not harmed.

“We are not burdening the patients as they have medical insurance coverage. It is okay to prescribe a few tests. The problem of ethics arises when doctors subject patients to unnecessary or avoidable medical procedures or even hospitalisation,” said the senior practitioner.

But not all doctors were so forthcoming about their remuneration. Most vouched they draw monthly salaries and don’t receive commissions. “I do not know what others get. I get a monthly salary — that too a decent one,” said an ENT specialist who works for a reputed clinic in Abu Dhabi.

“I have not heard about any commission given to doctors as I was working in the public sector. I joined a private hospital just five years ago,” said another.

Georgey Koshy, Interventional cardiologist Universal Hospital in Abu Dhabi was candid enough to admit that incentives are a common trend worldwide. “Every place under the sky has it. If you ask me, I am absolutely against it and I do not take it either,” said Koshy.

According to him, doctors cannot be blamed entirely as incentives are offered by private hospitals as part of their marketing strategy. “There will be temptation to overbill when incentives are offered to achieve revenue targets. But again, a doctor who takes incentives can very well uphold his professional ethics and moral high ground if he follows the correct guidelines,” asserted Koshy.

His employer, Dr Shabeer Nellikode, managing director of Universal Hospital, said his doctors are offered an annual bonus but no commission. “We do performance appraisals based on clinical indicators and patient satisfaction and not on numbers. Incentives are offered as yearly bonus for departments to reward their team,” said the specialist neurologist.

B.R Shetty, managing director of the NMC Group of Hospitals which is one of the biggest health care service providers in the sector, said he has always campaigned against putting doctors on incentives.

“It amounts to bribing doctors. None of the doctors in our 10 hospitals in the UAE are offered any sort of commission.”

NMC offers general practitioners salaries ranging from Dh15,000 to 25,000, plus other benefits including housing allowance. “A specialist earns between Dh30,000 to Dh60,000 depending on his experience and we have consultants who are paid anything between Dh80,000 and Dh300,000,” said Shetty.

According to him, if doctors are offered competitive salaries by hospitals, there is no need to lure them by commissions which in turn adversely affects the quality of health care. “A hospital should look after its doctors, but more importantly it should protect its patients from any form of exploitation,” he said.

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  • anonymous

    Aug 8, 2013 12:17

    doctors should be thrown in jail for accepting expensive gifts. Their names should be published in newspapers to discourage others.this has indeed become a disease of the mind.raids should be conducted on hospitals and patients should boycott such hospitals.

  • ABDUL MATEEN

    Aug 8, 2013 12:08

    My employer had once downgraded health insurance cards of all employee due to this reason. This is very serious and there should be some measures to control such over charges which initially goes to insurance company and they later increase the premiums.

  • Nobee Perera

    Aug 8, 2013 10:53

    As soon as Doctors see Health Insurance cover, they recommend maximum medicines and other tests. I am living for the last 34 years in the UAE and I have experienced this. I always tell my doctors don't pump my body full ofmedicine and chemicals.

  • Anonymous

    Aug 8, 2013 10:39

    This is very true and pathetic. This is not only prevalent in the capital, but also in Dubai and Sharjah.

  • mashoodn

    Aug 8, 2013 10:16

    this is an open secret in the medical field.

  • Joseph

    Aug 8, 2013 9:53

    Hi, this is one of the very common factors in Dubai clinics for exploiting patients as they know all people holdinsurance and the limit of usage.Most people immediately rush to clinics even for minor seasonal cold that can be treated at home - our mentality is why we should avoid going to doctor when we are paying for insurance premium. but they forget that the more claims you have the higher is the premium that you or your company would be paying . We recently visited by medical team called 'Mobile Doctors' who we can contact for any medical advice before we rush to clinics. they will assess and advice you the best possible solution based on your condition and urgency of medical aid required. meaning if the symptoms we describe could be treated at home thru' first aid otherwise they will guide us for the right medical treatment with right clinic to visit.

  • Reshma

    Aug 8, 2013 7:15

    I wish to express my experience here recently that i faced with a famous medical center in Sharjah, a fertility clinic where i was asked to conduct a few blood tests which cost me Dh1185, and most of the blood test results turned out to be bad, out of which, there was one test which cost me Dh450 and that returned with a value stating'reduced' and the staff at the medical center put me in adilemma saying, i would not be able to concieve normally and IVF is the only option which needs to be done at their own hospital in Kerala, India, I packed my bags immediately in disappointment but thought of taking a second opinion and hence visited a different doctor in Kerala, who saw my blood test results, repeated a few, except for thisparticular one the other tests turned out to be normal and hence we repeated this test (which costed me just Rs1,500 in India (Dh100) and the result showed 'optimal' and I had no issues in concieving.The doctor at the Dubai medical center also prescribed me a few costly medicines which other doctors i consulted didnt even know why i was given, as I was not diagnosed with any issue for which these medicines were to be used. So peoplebeware, always take a second opinion.

  • Faisal

    Aug 8, 2013 5:49

    Maternity should be kept in Package for Insurance cards. This is my personal experience during the time when my wife was pregnant, often the doctor said I cannot see this clearly you need to go and do this scan downstairs. Even my brother was adviced to do so many scans during hiswife's pregnancy. If it was a package they would have done limited Scans as per the package. Medical Insurance providers should insist on packages rather that direct billing for maternity.

  • Ali

    Aug 8, 2013 5:18

    100% in agreement as I am myself a victim of one such incident in one of the most famous private hospital chains, where upon birth of my son they tried to scare me by saying that things like he wont survive or he will not have anormal life etc etc and when I confronted the doctor and management I was unofficially told by a senior member that we have to meet our target like any other salesperson. What a shame it is that life saving profession today is turning out to be a money making salesman type commission based business. May Allah have mercy on all of us.

  • N KHAN

    Aug 8, 2013 1:51

    I work in a reputable clinic as a consultant and never have worked on incentives or known that. My salary is good and my employer respects what I do. We never discuss revenue but only the quality of care and maintaining our good reputation. Quantity always follows quality rather than other way round. Our aim is to do the best and having worked in Europe we recognize how grateful patients are here if given an excellent service, The satisfaction from treating ill patients is our incentive.No amount of money can bring that reward.

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doctors should be thrown in jail for accepting expensive gifts. Their names should be published in newspapers to discourage others.this has indeed become a disease of the mind.raids should be conducted on hospitals and patients should boycott such hospitals.

anonymous

8 August 2013 13:42jump to comments