MEDICAL scheme Discovery Health is considering using machines that will scan fingerprints to try and fight fraud in hospitals and deal with wayward members.
Speaking at the Discovery Healthcare media summit yesterday, chief executive Jonathan Broomberg said the fraud involved patients using false membership cards when they are admitted tohospitals.
"This type of fraud is hard for us to detect and we are considering using biometrics to get patients' fingerprints to curb this fraud," Broomberg said.
He also expressed concern about medical doctors and administrators who colluded with patients to make it seem that they had been admitted in hospital, just to claim R5000 a day.
"The money will then be shared between the patient, doctors and administrators," he said.
Broomberg said the company had managed to improve its fraud savings by 84% and saved a staggering R254-million in 2012 compared to 2011's R138-million.
He said R78-million was saved in forensics, R73-million in hospitals and R66-million on non-disclosures.
"The cases of individual fraud include members who didn't disclose a pre-existing illness before they became members.
"We also see criminal syndicates trying to gain control of the system," he said.
The company also saw a significant reduction in the number of patients who also used medical aid cards belonging to other people when visiting general practitioners.
"A doctor would tell us that though they know that the patient is committing fraud, they accept the cards and treat patients out of compassion," Broomberg said.
He added that there had been a significant increase in high-cost patients as the number of patients who contracted chronic diseases had doubled over a period of 10 years.
High-cost patients are those who each claim more than R500000 a year.
In 2002, there were 13 patients out of 10000 who were regarded as high-cost patients.
"In 2012 the number of patients more than doubled and now stands at 28," he said.
He announced that Discovery was encouraging medical specialists who worked as individuals to group themselves and start highly specialised medical centres. - sibanyonim@sowetan.co.za
Medical aid tackles fraud
MEDICAL scheme Discovery Health is considering using machines that will scan fingerprints to try and fight fraud in hospitals and deal with wayward members.
Speaking at the Discovery Healthcare media summit yesterday, chief executive Jonathan Broomberg said the fraud involved patients using false membership cards when they are admitted tohospitals.
"This type of fraud is hard for us to detect and we are considering using biometrics to get patients' fingerprints to curb this fraud," Broomberg said.
He also expressed concern about medical doctors and administrators who colluded with patients to make it seem that they had been admitted in hospital, just to claim R5000 a day.
"The money will then be shared between the patient, doctors and administrators," he said.
Broomberg said the company had managed to improve its fraud savings by 84% and saved a staggering R254-million in 2012 compared to 2011's R138-million.
He said R78-million was saved in forensics, R73-million in hospitals and R66-million on non-disclosures.
"The cases of individual fraud include members who didn't disclose a pre-existing illness before they became members.
"We also see criminal syndicates trying to gain control of the system," he said.
The company also saw a significant reduction in the number of patients who also used medical aid cards belonging to other people when visiting general practitioners.
"A doctor would tell us that though they know that the patient is committing fraud, they accept the cards and treat patients out of compassion," Broomberg said.
He added that there had been a significant increase in high-cost patients as the number of patients who contracted chronic diseases had doubled over a period of 10 years.
High-cost patients are those who each claim more than R500000 a year.
In 2002, there were 13 patients out of 10000 who were regarded as high-cost patients.
"In 2012 the number of patients more than doubled and now stands at 28," he said.
He announced that Discovery was encouraging medical specialists who worked as individuals to group themselves and start highly specialised medical centres. - sibanyonim@sowetan.co.za
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