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Govt intervention key to combat insurance fraud, Clyde & Co claims

Government intervention is key to combating health insurance fraud, international law firm Clyde & Co has claimed.

Following recent actions taken by the Health Authority for Abu Dhabi and the Dubai Health Authority to uncover health insurance fraud, Wayne Jones, Clyde & Co insurance and reinsurance partner, said active health authorities in the region can radically transform the industry and wipe out insurance fraud. 

“Whilst insurers have no doubt taken fraud seriously within the context of their own schemes in the past, it is the recent advent of active health authorities in the region, which can radically transform the landscape of the industry,” he said.

Jones said joint initiatives with the insurance industry and other stakeholders are also likely to reap positive results when combating fraud.

He added: “Not only can they play a large role in structuring the industry, but the legislation under which they are mandated gives the authorities extensive powers to patrol the industry as well.

“Early action at this stage of the market’s development in taking action against those swindling the system will send a strong message to the market.”

Jones also warned as the market develops, “the opportunities for fraud are likely to continue to present themselves, and it will take determined and concerted efforts by the industry and regulators alike, to make sure that effective means of dealing with this plague are implemented”.

Third-party administrators also have a role to play in combating fraud, said Jones.  He added: “Insurers and TPAs have a large role to play in effectively policing their own networks and programmes to monitor and deal with fraudulent conduct.  The fact that networks are contractually appointed gives insurers and TPAs an effective means of dealing with any culprits, backed up by the threat of referral to the police and criminal courts if necessary.”