The initiative was part of the measures taken by the company to prevent fraud attempts and misuse of the medical insurance to protect its 2.1 million customers from wrong practices of some medical care providers.
Healthcare providers found to be committing fraud are immediately reported to the Health Authority — Abu Dhabi (HAAD) and later referred to the courts for further action. In 2011, HAAD received more than 1,400 complaints as against 1,160 received in 2010 and 1,500 during 2009.
In the past, several doctors and insurance companies were taken to court by the authority for offences that included making fraudulent claims, using fake insurance cards and charging for services that were not provided. HAAD also  issues fines ranging from AED10,000 to AED20,000 per violation to clinics, pharmacies, and medical professionals. Violations included replacement of prescription medications with non prescribed drugs, medical and non medical consumables, and non medical items.
Dr. Michael Bitzer, Daman's chief executive officer, said: "Fraud and abuse in medical insurance poses a risk to our members' health and leads to financial losses, not just for the insurer but for the members in the form of inflated claims on their policies. Daman maintains zero tolerance for such violations and is taking every measure to limit the damage from fraud and abuse of health insurance".
In 2011, Daman introduced a rigorous auditing protocol and prudent investigation procedures to support its medical auditors and investigators in detecting cases of potential fraud and abuse. The company also increased the number of professionals serving on its medical audit and investigation team to 25 professionals with medical backgrounds.
The team in 2011 investigated over 1,000 cases and audited over 500 medical service providers, including hospitals, clinics and pharmacies. The auditors routinely conduct a trend analysis of medical service providers for indication on potential cases of abuse or fraud. Daman also instituted a new fraud and abuse legal advisory team that works closely with government authorities on these cases.
"Medical investigation has been a priority for Daman from the time of its inception. Stated Dr. Jad Aoun, chief medical officer at Daman. "We have planned a number of initiatives for 2012 to support this function, and are confident of further reducing instances of fraudulent claims and losses incurred from such professional misconduct".
Added measures to reduce instances of fraud and abuse include the introduction of a revised set of stringent guidelines and bolstering the medical investigation and audit team with further resources.