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Medical licences revoked for flouting insurance rules

Licences of three doctors revoked and legal action taken against one facility

Gulf News

Abu Dhabi: The licences of three doctors in Abu Dhabi have been revoked for violating the terms of the emirate’s health insurance Act, the Department of Health announced in a statement sent on Tuesday.

Legal measures have also been advised against one establishment for violations.

“As a result of our commitment to providing quality health services, the department closely safeguards the right of individuals and establishments against insurance violations. We will continue our efforts to ensure that health facilities and workers comply with the regulations, and contribute to the sustainability of the health system, through the proper use of health insurance benefits,” said Abdullah Al Hamed, head of the department.

Among the recent spate of violations, a doctor was found providing incorrect information about a patient to obtain insurance pre-approval. The department found that the doctor had requested insurance coverage to conduct more dental procedures than the patient needed, and therefore revoked his medical licence. The case has also been referred to the legal department to recover any excess amount paid to the doctor’s health-care facility.

In another incident, a patient’s health data was manipulated by a physician to show that he needed additional treatment, including a surgery. This inaccurate report was supported by the opinion of another physician at a different facility. The department, therefore, revoked the professional licences of both doctors, and has asked for the insurance amount obtained unlawfully by both health-care facilities to be returned.

The two facilities are also strictly forbidden from providing the service that was illegally requested.

Another health-care facility was also found to offer dental services by claiming that these were covered under The National Health Insurance Company’s Thiqa insurance plan for Emiratis. This coverage has not yet been confirmed, but patients have availed of the dental services. The department therefore excluded the facility from its insurance network, and referred it to the legal department for further action.

Al Hamed said such violations would not be tolerated, and urged residents to track their health insurance claims through the department’s smartphone application.

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