Daman's Medical Audit Department dispatches "Mystery-Shoppers" as an active measure to combat fraud

Daman's Medical Audit Department has employed and dispatched a team of 'Mystery-Shoppers' to a number of healthcare providers and has thus uncovered various cases of fraud.

Daman revealed that one provider filed false information with respect to the patients' symptoms, medical history and diagnoses as well as claiming for excessive tests and treatments that were not conducted.

Dr. Michael Bitzer, Daman's Chief Executive Officer, commented:

"It is our duty to protect our customers' best interest; fraudulent claims that go undetected will affect the underwriting process and ultimately result in unfairly increased premiums for customers." He continued, "Our Medical Audit Department employs trained and experienced professionals who are constantly working on detecting and preventing abuse to ensure the highest level of services."

Dr. Rainer Petzel, Head of the Legal Department at Daman said, "Health insurance fraud occurs across the world; through our Medical Audit Unit we are attempting to control and minimize the levels of fraud and abuse within the UAE ."

Daman has also uncovered a number of fraudulent cases where pharmacies have switched prescriptions based on patient requests and dispensed alternative products and cosmetics that are not covered by their insurance plans. Medical prescriptions are intended to supply the patient with specific medication for treatment of the diagnosed illness and this can not be exchanged with any other product, e.g., cosmetic products..

Depending on the severity of the case, violating providers were either issued warning letters stating that the matter would be referred to HAAD and/or frozen from operating within Daman's healthcare providers' network. .

Dr. Jad Aoun, Daman's Chief Medical Officer, commented "Insurance fraud is a very serious criminal offense that is not to be taken lightly." He added: "Daman has imposed severe penalties on implicated providers and has also launched a full investigation to combat such fraud."

Dr. Aoun concluded:

"Daman's Medical Audit team is instrumental in ensuring that Providers comply with Daman policies to ensure the correct usage of the health insurance scheme and to halt such occurrences."

Daman has established a highly ethical framework and operational criteria that healthcare providers must adhere to in order to be contracted into Daman's network whereby any violation of Daman's policies will be met with firm action.