DOHA: The National Health Insurance Company (NHIC) has warned hospitals and clinics against manipulating the National Health Insurance Scheme (Seha) to their benefit, saying this will be considered misuse of public funds and invite stern action, including closure of the facility.
Misuse of the scheme could include prescribing unnecessary medicines, repetition of medical tests or providing treatment not included in the insurance coverage, such as cosmetic surgery that is not medically required.
Dr Faleh Mohamed Hussain, acting CEO of NHIC, said yesterday that the NHIC would conduct surprise raids and deploy “secret patients” to detect malpractices.
These patients would visit a hospital or clinic in the Seha network and ask for medication or medical check-ups that they do not require.
The NHIC will also inspect patient files randomly by matching them to claims sent by the service provider to the company and comparing medication and tests prescribed for the patient.
“Such violations constitute a criminal offence since the providers are acquiring public funds illegally. This could result in closure of the facility,” said Faleh Hussain.
The Qatar Council for Healthcare Practitioners (QCHP), the body under the Supreme Council of Health that investigates complaints against medical practitioners, is authorised to withdraw the licence of the erring facility, he added.
He said NHIC will also conduct inspections based on complaints received from Seha beneficiaries. Since the launch of the second phase of the scheme, which covers all citizens’ basic health needs, NHIC has received about 100 complaints about the providers.
Most of the complaints were related to refusal to provide the requested medical services or medicines or demands for payment from the beneficiaries for services for which they are not supposed to pay under the scheme, said Faleh Hussain.
He said NHIC was preparing for the third phase of Seha, to be launched by the end of next year to expand the coverage to expatriates. “We are having discussions with the officials concerned to decide the value of the annual premium and the services to be covered,” said Faleh Hussain.
As for Seha coverage for visitors to the country, the official said NHIC was working with the Foreign Ministry and Ministry of Interior in this regard since it would be linked to the issuance of visas.
He said the number of hospitals and clinics in the Seha network will double in the coming months to about 100, from the existing 52.
Faleh Hussain also revealed that more than 150,000 citizens have benefited from the scheme in the first two months after the launch of the second phase on April 30.
A total of 3,750 citizens have availed of dental services which was included last month.
He said organ transplant is covered by the scheme but does not include organs brought from abroad. Patients treated under the National Organ Transplant Programme are also not covered by the scheme.