Medical Fraud
Medical insurance fraud is a deliberate act by the policyholder, insured or medical service provider to obtain compensation or undue benefits for themselves or others by tricking, concealing or misrepresenting information.
Examples of Medical Fraud
Medical Fraud is a deliberate act by the policyholder , insured or medical service provider to obtain compensation or undue benefits for themselves or others by tricking, concealing or misrepresenting information, for example :
- Using the medical insurance card by someone else
- Mislead to accurately report medical history & pre-existing conditions
- Asking for services, medicines, and/or procedures that are not provided, not covered, or for more expensive treatments or medicines than those prescribed
- Visiting same or multiple hospitals to receive unnecessary or duplicate medicines
The policyholder's liability towards fraudulent transactions
- Be aware of attempts by medical providers and others to convince you that everybody else is profiting so you may as well try to reap the benefits of insurance fraud
- To avoid unwanted medical procedures, always ask the doctor about the provided services and why you need them
- Do not allow anyone to use your medical policy
- Carefully review your claims & bills before signing them, and question charges for procedures that were not provided
- Inform and call salama company when you detect or suspect fraud
Fraud detection mechanisms in motor insurance
- A dedicated Medical Fraud department
- Applying fraud control systems
- Cooperation with regulators such as CCHI or Insurance Authority
- A toll-free hotline which you can call to report suspected fraud
- A special Fraud reporting Email monitored by Fraud department Team
The Negative Impacts of motor fraud
- Higher medical insurance premiums to meet the increase in the loss ratio
- Stop issuing medical insurance policies to reduce fraud claims and loss of access to insurance coverage
- Cancellation of the insurance policy
- Cease of dealing with medical service providers and thus deprive patients of distinctive treatment services
- Claim rejection
- Health harm to the insured due to tampering with his medical history if the medical card is used by others
- Business financial losses resulting from fraudulent claims
