New smart card to reduce fraudulent claims

August 6, 2008

, NAIROBI, August 6 – Medical Insurance provider Resolution Health has launched a new smart card that is expected to reduce fraudulent medical claims by 25 to 40 percent.

Speaking at the launch of the Sh30 million product on Tuesday night, Chief Executive Officer Peter Nduati revealed that 10 to 15 percent of medical claims for children in the country were fraudulent.

Resolution Health had paid out claims of up to Sh360 million by mid 2008, and was projecting a total annual payout of Sh590 million.

“If we were to save even 10 percent of the Sh590 million we were projecting for the year, it would come to Sh59 million much more than the Sh30 million we have invested in this project,” noted Nduati

The card was developed by Smart Applications International Limited, whose Managing Director Pauline Muriuki said worldwide statistics placed fraudulent medical claims at between 20 and 40 percent of total claims.

“In the Kenyan market, fraud cases are as high as 50 percent though the average is between 20 and 40,” she emphasised.

Muriuki revealed that companies are reporting up to 65 percent reduction in costs after blocking fraudulent claims.

Nduati pointed out that there were three levels of fraud in the country; identification fraud (where somebody uses another persons card), over utilisation (policy holders using the card after expiry), and hospitals charging more than the negotiated tariff.

The new card has a metallic chip which contains bio-data and membership information and upon presentation to the medical card provider, registration of an individuals fingerprint would take place.

“Thereafter whenever the hospital needs to charge your medical account, you will be required to use your fingerprint for identification,” explained Nduati.

Currently only 41 medical service providers are using the card processing equipment.

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