SAUDI ARABIA

Health insurance council stops business with eight optic branches for violations

May 20, 2018

Fatima Muhammad



Saudi Gazette

JEDDAH — Eight branches of one optical business have been stopped from working in the health endurance sector in Saudi Arabia for violating insurance regulations, and the case has been transferred to the Bureau of Investigation and Prosecution.

The branches of the optical business were found guilty of providing services that are not covered by the health insurance by fraudulent methods. The branches transferred the services that is not covered by the insurance firm, to that which is covered by the firm and then request for compensation.

The council has informed all health insurance companies of the decision, who in turn are required to inform patients so that they do not do business with this optical company.

Yasser Al-Ma’arik, the spokesman of the Council of Cooperative Health Insurance, noted that the investigation teams have noticed violations in these branches while making regular tours.

He explained that the council opts to organize the health insurance processes between different parties and protect the rights of all involved. Thus the council takes the responsibility of supervising, monitoring and organizing the health insurance industry to avoid any violations.

The council organizes field tours to know the phenomena in the market and study them, said the spokesman. In 2017 the council visited 25 hospitals and medical complexes. One hospital and one medical complex were deprived from health insurance. Two health insurance companies were also stopped and in all five health insurance companies were fined.

The violations of the health service providers include: Not double checking the IDs of individuals receiving the health insurance, holding an amount of money until the hospital received approval from the insurance company during evening shifts, sending requests for approvals when not needed and not providing health insurance to Saudis employed at the private sector and their families.

Al-Ma’arik added that the council has the right to stop any party permanently or for a specific period of time until they correct their status.

In 2017 the council received over 53,000 complaints over 48,000 of which are against health insurance companies noted a press statement issued by council. The council added that it has enhanced its services in this regard, in 2016 the council received only 5,600 complaints.


May 20, 2018
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