What can I do to help combat fraud in the healthcare system?

Health care fraud is a white-collar crime, which is on the rise, it is likely that this crime will continue to increase in the future.

For individuals (Bupa Arabia insured members), here are a few things to think about to ensure your contribution to uphold the integrity of the healthcare system and minimizing the fraud, waste, and abuse:

  • Keep your health insurance and personal information protected.
  • Never share your National ID/Iqama OR Membership card with anyone and ensure that your records, especially mobile and IBAN Number is updated in Bupa Arabia.
  • Never share your OTP (One Time Password) received from Bupa Arabia with anyone.
  • Be informed about your role as a patient or insurance consumer, and don’t be afraid to question your healthcare provider about procedures or billing items you don’t understand.
  • Be responsible for your own healthcare and treatment, and seek services from an appropriate source.
  • Report fraud if you come across it at BAReport.abuse@bupa.com.sa OR through Bupa Arabia’s Web site www.bupa.com.sa and in the "contact us" section there is an area to report a “Report a Fraud or Abuse”.

Definitions of Fraud, Waste and Abuse:

Fraud – Intentional deceit by any insurance party leading to obtain benefits, funds, or privileges which exceed the allowed limits to the relevant individual or entity. This is when an individual or organization intentionally falsifies information for financial gain.

Waste – Providing insurance/medical services without exercising the duly recognized reasonable amount of medical or insurance precautions that results in material or moral harm to one of the insurance parties, which would not have occurred but for the manner in which the negligent person has acted.

Abuse – Practice by any insurance party that may lead to obtain benefits or advantages that are not eligible to such party who has no intention to deceit, deceive, misrepresent, or distort facts to obtain such benefits.