Medical Insurance Fraud Exposed

Fraud has continued to rip off the Kenyan medical health insurance system meant to lighten the medical cost burden for Kenyans.

Here are some of the ingenious ways perpetrators have invented to execute fraudulent activities and find tips on how best to deal with each situation.

Two tier pricing

Medical providers have been known to apply two tiers pricing for their service. Usually a patient with a medical card is charged more than one who pays cash. To avoid falling prey to this, always confirm the fees such as consultation fees before you can hand out your card for billing or even confirm each service that you received with the person at hand then you can reconcile the billing thereafter.

Pricing inflation

Hospital and clinics have been reported to inflate bills by making patients undergo a series of unnecessary tests. In most cases unsuspecting patient will go through with the tests since they trust the doctors’ word. To evade this, ask why it’s needed and if it’s necessary to take the tests before you can agree to them.

Identity theft

This is a growing trend where health facility use the identity of an insured patient and bills for services not rendered. If this has happened to you report the case to your insurer or the insurance regulation authority (IRA), they will be able to follow up on the case and hopefully apprehend the culprits.

Fake prescription

Cases of hospital pharmacies charging for branded medicine yet prescribe generic versions have also been reported. Always confirm that you have received the medicine prescribed and if not ask for the generic version which should be a cheaper option. Make sure that this reflects on your billings.

Altered documents

Medical service providers have also been known to alter documents to increase claim amount. To avoid this always keep record of your receipts, this way, you can always track your spending. If you suspect any fishy activities on your account, don’t hesitate to call your insurer for confirmation and they will follow up if necessary.

Individual fraud

Some insured individuals have also been nabbed allowing a different individual to access medical cover using their credential. This act is prohibited and could land you in jail.