The Dubai Health Authority (DHA) have taken positive action and procured their rights to issue a number of fines for regulatory violations, against market stakeholders, for non-compliance under Law No. 11 of 2013 concerning health insurance in the Emirate of Dubai.
The Dubai Health Authority (DHA) have taken positive action and procured their rights to issue a number of fines for regulatory violations, against market stakeholders, for non-compliance under Law No. 11 of 2013 concerning health insurance in the Emirate of Dubai.
The DHA had originally taken a non-punitive approach in order to allow the market extra time to deal with the new regulatory changes and ensure they are fully compliant. However, on Tuesday 11 April 2017, the DHA issued a press release stating that it has fined 25 health centres, clinics, insurance brokers and insurance companies for violating the law and referred six clinics to prosecution for potential fraudulent activities. The fines range between AED 10,000 to AED 80,000 and these were levied following violations that were found during surprise and routine inspections conducted by the DHA’s Health Funding Department (HFD) as well as from member complaints.
The DHA reported that some of these fines relate to healthcare providers altering the diagnosis to get claims paid, submitting claims for non-performed services and in some cases, submitting partial case details to get coverage and get claims settled. There are also instances of the providers ordering unnecessary services and laboratory investigations or the provider submitting invoices and getting payments for treatments before completing the services. On many occasions, the patients do not come back to complete these services, such as dental or physiotherapy sessions and the providers make a windfall gain.
The DHA have also listed violations made by the insurance companies, such as, delay in the insurers not issuing health insurance cards or activation of Emirates IDs and advertising wrong information without prior verification from the DHA. Practicing health insurance in Dubai without a proper license from the DHA or the HFD or dealing with companies, which are not licensed to practice by the DHA or HFD, are the other major issues that have been noted by the DHA.
The implementation of fines, which are listed in Executive Council Resolution No 7 of 2016 (resolution), is the DHA’s tool to prevent abuse of the law. If these fines do not deter the offenders, the DHA plans to publically name and shame the violating providers, health insurance brokers and insurance companies. Stiffer penalties such as partial and full suspension of practice and cancellation of license are also being planned.
Insurance contracts are based on the concept of ‘Uberrima Fides’ which means “utmost good faith”. This forms the basis of all insurance contracts, and all stakeholders including insurance companies, third party administrators, healthcare service providers, practitioners registered with the DHA, employers and individual sponsors must ensure full compliance with the law in order to come together and work towards a sustainable model of health services. It is noteworthy that the final deadline for mandatory health insurance under the law was 31 March 2017. We expect more fines to follow from the DHA over non-compliance once the visa and immigration systems are aligned with the DHA and HFD systems.
