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.