JEDDAH — Health insurance companies lose 20 to 30 percent of premiums they collect from customers as a result of fraudulent practices by patients, doctors and healthcare providers. This situation has forced many insurance firms to increase premiums to offset losses. Dr. Fahd Al-Anazi, an insurance expert, said fraudulent practices in healthcare services include prescribing medicines and conducting surgeries not covered by the policy by manipulating the system. "This kind of manipulation and exploitation has been the main reason for the increase in the health insurance cost in the Kingdom," Al-Anazi told Al-Riyadh Arabic daily. He emphasized the need to combat the wrong practices and enhance insurance awareness of the public. "About 30 percent of premiums collected by insurance firms go to offset losses caused by dodgy claims," he pointed out. He said some doctors receive commissions from hospital authorities considering the bill of patients including the cost of medicines and laboratory investigations. "We have noticed abnormal exploitation of health insurance by individuals and companies," Al-Anazi said. "Integrity and trustworthiness of doctors and hospital managements are key to solve the problem," he added. He urged the authorities to monitor unusual practices and activities of hospitals and polyclinics to prevent manipulation and exploitation of health insurance services. Maher Al-Joairy, another insurance expert, said prescription of excess medicines and unnecessary laboratory investigations is one of the prevalent forms of fraudulent practice in the sector. "Doctors, hospitals and patients reach agreements for conducting medical analysis, prescribing medicines and performing surgeries that are not covered by the policy. These practices increase the cost of insurance coverage," he said. "Insurance companies adopt various methods to save themselves from fraud. They will check medical requirements of patients before starting treatment. They will also ensure whether the quality and method of treatment are suitable or not," he explained. Insurance companies will also review reports of a hospital's handling of different medical cases. "Insurance companies around the world take measures to reduce the impact of fraudulent practices on them," Al-Joairy said. According to him, insurance firms lose at least 20 percent of premiums collected from customers as a result of fraud. Yasser Al-Maarik, spokesman for the Health Insurance Council, said more than 12 million workers in the private sector enjoy health insurance. He said the council supervises health insurance coverage being provided to 40 percent of the Saudi population. Twenty-seven health insurance companies and nine insurance management firms extend health insurance coverage to clients through 4,543 healthcare providers across the country. "The council deals with complaints received from the insured, especially when insurance firms deny them services specified in the policy," Al-Maarik told Al-Riyadh.
