Breaking

Insurance Fraud Researchers Set Doctors Up- Ian Clarke

The news of the fraud came after a survey done by the Uganda Insurers Association found wide-spread cheating from hospitals, which forced some insurance to erase some of the clinics from the list of providers, at the beginning of this month.

Audio 3

Dr Ian Clarke, the proprietor of International Medical Centre (IMC) group of clinics says that recent actions taken by insurance companies to terminate them from serving clients with health insurance policies and reinstating them without an explanation has left everyone confused. 

The news of the fraud came after a survey done by the Uganda Insurers Association found wide-spread cheating from hospitals, which forced some insurance to erase some of the clinics from the list of providers, at the beginning of this month. 

The fraud according to the researchers included fictitious claims, treating non-card holders, conducting unnecessary checks and using the two-tier pricing where cardholders were charged highly than cash holders.  

Dr Ian Clarke said that while the researchers visited 17 of his clinics around the country, they put doctors under pressure and in the end trapped them into committing mistakes.   

//Cue in; “What I know...    

Cue out… give me something.”//   

Clarke said while he understands insurers were under pressure too because of the losses they have been making in claims, the move to immediately reverse their actions have left clinics tainted in the bad shade, yet insurance is now being promoted as one of the avenues that will help the country achieve universal health coverage. 

// Cue in; “I don’t really...  

Cue out…. reversed their decision.”// 

But, although he is unhappy with the process, Clarke acknowledges that there’s a lot of fraud in the insurance industry and also that not many Ugandans even those that are insured know what health insurance is about. 

He adds that for health insurance to make sense, people need to understand that they can payout of the pocket for minor illnesses since endless trivial hospital attendances increase administration costs which too may hike what one is charged. 

//Cue in; “When people get... 

Cue out… doesn’t make sense.”// 

However, while it looks that insurers and hospitals have not yet agreed on the way forward, experts are predicting that the continuous fraud established within these hospitals will only drive insurance rates high.

Entities

Keywords