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There has been an increasing number of member/payer complaints against providers about extended and unnecessary in-patient admissions.
There has been an increasing number of member/payer complaints against providers about extended and unnecessary in-patient admissions.

Dubai - Healthcare providers to pay for unnecessary medicines and tests.

by

Asma Ali Zain

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Published: Tue 28 May 2019, 7:00 PM

Last updated: Wed 29 May 2019, 4:27 PM

Healthcare providers have been asked not to carry out unnecessary treatments, lab tests - or prescribe unnecessary medicines to patients and prolong treatments - after a number of complaints were raised.
The Dubai Health Authority (DHA) has issued a circular stating that if investigations show that a patient's medical bills have been inflated due to unnecessary treatments, the hospital will have to bear the costs.
Saleh Al Hashimi, CEO of Dubai Health Insurance Corporation (DHIC), told Khaleej Times in an exclusive interview that the emirate wants to promote optimum standards based on the Dubai Standards of Care. "We want providers to pay attention to the disease and not burden the patient with extra tests or medicines," he said.
According to the circular, there has been an increasing number of member/payer complaints against providers about extended and unnecessary in-patient admissions, as well as medical treatments that include laboratory, diagnostic and any other services.
In addition, there is an equally increasing number of complaints from providers against payers about not settling claims for various reasons, said the circular.
"There is a growing number of complaints and disputes from members and payers alike. For example, a patient is admitted for a prolonged period of time and, once stabilised, inpatient admission is unnecessarily requested even though the patient can be safely and medically discharged," read the circular.
"This is also applicable to medically unjustified lab/diagnostic tests or prescribed medications. Providers have raised the issue of numerous cases of emergency inpatient admissions, for example, where when a patient is stable and fit for transfer, and where the payer does not transfer the patient nor settle the outstanding bill upon discharge," it added.
Filing a complaint
The circular read that any complaint raised must be accompanied with a detailed explanation of the scenario and an accurate timeline of events, in addition to medical evidence supporting the claim.
Once sufficient evidence is compiled as deemed fit, it will be raised to a medical committee appointed by the DHIC, it said. After a thorough investigation, the committee will issue a decision on the specific case.
The circular also included details about the repercussions of carrying out unnecessary practices.
"(Decisions) may include requiring the medical provider to bear the cost of the excessive treatment/admissions in part or in whole, or requiring the payer to settle the outstanding amount in part or in whole, or any other third parties involved which may have prolonged or caused the increase in the treatment/medical bill. The decision may also include an increase or decrease in the patient share," it stated. Al Hashimi also said that, sometimes, the patients ask for more tests, thinking these are better for them. "In some cases, doctors are extra careful," he added.
Quoting a study, Al Hashimi said antibiotics are prescribed for cases even when 70 per cent of upper respiratory infections are viral.
He said payers have the right to audit the bill. "They can ask or reject the bill even if the service has been rendered."
asmaalizain@khaleejtimes.com
 


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