Doha
National Health Insurance Company, which manages the basic mandatory national social health insurance scheme ‘Seha’ across Qatar, yesterday said it “uncovered” several instances of suspected “abuse” of the scheme.
"As part of the regular audits, the company has uncovered several instances of abuse of the scheme, which have now been forwarded to the country’s healthcare regulator, the Supreme Council of Health for further investigation and action," NHIC said, launching its 'Be Our Eyes' campaign, aimed at public support in reporting suspected frauds and abuse.
As many as 549 complaints have been received so far, NHIC acting CEO Dr Faleh Mohamed Hussain Ali told reporters yesterday.
The complaints were of varying nature, which includes denial of services, eligibility denial, availing of services in other’s cards etc, he said.
Highlighting the built-in fraud and abuse detection systems within Seha, he said post-payment and ad-hoc audits not only allow NHIC to audit claims from all providers but also ensure an additional layer of comfort in detecting unusual or suspicious activity.
“These audits further allow NHIC to suspend a payment of a suspicious claim until the audit investigation is completed,” he said.
"Seha is a major national initiative and was launched as a benefit to the nation and the public. For complete transparency; we follow well defined procedures and implement regular audits to ensure that fraud and abuse do not take place in any aspect of Seha’s operations," according to him.
NHIC asked both members and service providers to be cautious in using the scheme and warned against any attempt of fraud and abuse in using the benefits of the scheme and invited the public to be vigilant in reporting any cases of suspected fraud and abuse.
