DOHA: The Supreme Council of Health (SCH) has warned the public and health care providers against misuse of the national health insurance scheme (Seha) saying it has detected three cases of suspected fraud until now.
The National Health Insurance Company (NHIC) managing Seha has launched a campaign “Kun Ainuna” (Be Our Eyes) urging Seha beneficiaries to report any suspicious cases. All citizens are covered by Seha in the current phase, which will be expanded to expatriates in a later phase.
The NHIC yesterday also announced a delay in implementation of the scheme for expatriates saying the latter will be covered only by the end of 2016, instead of 2015 as originally scheduled.
Addressing a news conference yesterday, Dr Faleh Mohammed Hussain, acting CEO of NHIC said the company is closely monitoring the scheme and has been developing mechanisms to prevent manipulation. “There are a number of auditing procedures which can reveal any suspicious cases which immediately can be interrogated,” said Faleh Hussain.
He said the NHIC recently discovered three cases that can be considered as attempts to manipulate the system. The fraud was detected while the company was conducting regular audits on invoices. One case has already been referred to the SCH and reports about the second and third cases are being prepared.
If the SCH investigation confirms a violation of the law, action will be taken immediately including closure of the facility or other legal action. “We distinguish complaints related to misuse or manipulation from those raised because of misunderstanding of the health system or those related to the quality of services,” said Faleh Hussain.
For instance, one may find a doctor deliberately providing health services to a person he knows who is not covered by Seha by registering him in another person’s file, who is a Seha member.
The doctor may also provide specific health services and enter the details as “other services”.
“There are many ways of manipulating. It is easy for the supervisors to discover them by close monitoring,” said Faleh Hussain.
He said more than one million citizens have availed of the health services under Seha until now at more 180 health care facilities included in the scheme.
The scheme will soon be expanded to two primary health centres and five physiotherapy centres.
Implementation of the third and final phase targeting expatriates and visitors has been delayed until 2016-end, said the official.
The delay has become necessary to improve the electronic system and other technical aspects, train staff and complete studies started a few months ago about the third phase and decide what kind of services are to be provided to expatriates and their families and means of payment by employers, he added.
NHIC has so far received 549 complaints, mostly related to health services provided under the scheme, unjustifiable payment, refusal to provide treatment to some patients and eligibility of the patient for treatment. The Peninsula
