Rank: Elder Joined: 12/17/2009 Posts: 3,583 Location: Kenya
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quicksand wrote:mawinder wrote:A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder. Hii utashikwa. Insurers have doctors and pharmacists on payroll who examine courses of treatment (diagnosis processes, fees, procedures and drugs prescribed). This is an exact science....Sometimes even figures like 150,000/- invite keen examination, wacha hiyo yako ya 2.5 million ...things like prescription of fancy drugs when there are equivalent generics will get somebody under the radar ...remember doctors and pharmacists licenses can be revoked for fraud and malpractice, and insurers can delist hospitals where there is suspected fraud. Hard to get people to play ball. Unless its an inside job, some medics(mostly nurses) employed by the insurance companies to follow up the cases collude with doctors and patients to get a few coins - but its mostly small amounts < 100k, anything more than that attracts attention of the auditors and a few have been caught when they attempted instant major gains.
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