Dubai: The Dubai Health Authority (DHA) on Tuesday said it has fined 25 health centers, clinics, insurance brokers and insurance companies for violating the mandatory Dubai Health Insurance Law, while it has referred 6 clinics to prosecution for potential fraudulent activities.
Violations were found during surprise and routine inspections conducted by the authority’s Health Funding Department as well as from member complaints.
Dr Haidar Al Yousef, the Director of the Health Funding Department at DHA, said the fines imposed on these health centers, clinics, insurance brokers and insurance companies ranged from Dh10,000 to Dh80,000.
“Some healthcare providers and insurers didn’t comply completely with the Health Insurance Law and the circulars issued by the health funding department. We observed is through inspection visits, compliance meetings as well complaints received from different parties involved in the system. Therefore, we have resorted to fining them to avoid such acts in the future,” he said.
Dr Al Yousef revealed that the violations include but are not limited to:
1. Healthcare provider altering the diagnosis to get claims paid.
2. Healthcare provider submitting claims for non-performed services.
3. Healthcare provider submit partial case details to get coverage and get claims settled.
4. Beneficiary abuse of the health insurance card.
5. Ordering unnecessary services and laboratories.
6. Healthcare provider submit the invoices and get payment before even the services done to the members in which in most of the cases the patient don’t come back to complete the services – example: dental and physiotherapy sessions.
7. Delay insurance companies in issuing the health insurance cards or activation of the Emirates ID.
8. Non-compliance of the insurance companies with the customer satisfaction level required by the DHA, especially the front desk and employees handling call center.
9. Insurer market or advertise wrong information without verification from DHA.
10. Insurer practice health insurance in Dubai market without DHA/HFD license.
11. Insurer deals with unlicensed companies practicing health insurance in Dubai market without DHA/HFD license.
Dr Al Yousef said violating facilities got a warning followed by a fine and some were even referred to prosecution and might face criminal punishment due to potential fraudulent activities.
The fines range between Dh10,000 to Dh80,000, based on violation and the number of times the violation was repeated— in line with Law No. 7 of 2016. The law aims to protect the rights of individuals by ensuring that they are covered by the health insurance.
Employers and sponsors who fail to provide mandatory health insurance cover are now liable to a fine of Dh500 per month. Apart from the fine, no new visa will be granted and no existing visas renewed without health insurance, according to DHA.
