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New app spells end for insurance fraudsters

By Tony Mochama | June 16th 2020

When this writer met Allen Mayo, an insurance actuary, he could not hide his frustration at the slow pace of progress in investigating claims from Homa Bay for the year ended 2019.

‘What really bothers me is how disorganised the filing systems are. Important patient details have been lost, not to mention the difficulty in knowing if the claims have been inflated,” said Mr Mayo.

But he can now relax, thanks to a new filing system that promises to ease professionals in the industry significantly.  

Medi-Claim manages insurance claims for insurers by digitising medical records.

“Providing electronic medical records is in our DNA,” said Medi-Claim Marketing Manager Oscar Githinji of the new app.

From the second a patient walks into a health facility, their presence is electronically captured as they move from triage to the doctor, the laboratory and finally to the chemist to pick their medication. Medi-Claim is currently linked to 400 clinics and hospitals across the country.

“It saves patients the hassle of consulting with the treatment facility and counter-checking with the insurance company to know what options are available to them,” said Mr Githinji.

With the new system, it means invoices are immediately generated and insurance companies alerted in real-time.

“The one-time password, fingerprint (and soon, biometrics) means you can no longer bring that brother who looks a bit like you and pass him off as yourself.”

The medical insurance business has continually bled money for insurers.

This has seen providers record Sh3.5 billion in underwriting losses over the past decade.

In the nine months to September 2019, for instance, medical underwriting losses stood at Sh231 million.

This is despite the medical business being the second largest segment in general (short-term) insurance and accounts for a third of general insurance business gross premiums. Motor vehicle cover is the largest.

An up-to-date data bank of all registered medical personnel from the Kenya Medical Practitioners and the Pharmacy and Poisons Board is at the centre of Medi-Claim.

“In the same manner that the Law Society of Kenya (LSK) keeps a Roll-of-Advocates to prevent quacks in the court corridors, our EMR system will also incorporate and cross-reference only licensed and formally recognised medical personnel,” added Githinji.

He said the new system will render insurance fraud a mortal blow because when a patient walks into a health facility, all their transactions happen in real-time, allowing insurance companies to access an electronic replica of everything that is happening with their client.

Githinji said the core duty of any insurance company is to receive premiums against future calamities to property or for a client’s medical needs from routine to the emergency or catastrophic ones. “Claims management is a necessary evil for these companies,” he said. 

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