Healthcare fraud is costing country
Healthcare fraud - such as false claims, employee fraud, employee dismissals for unethical behaviour and doctors who commit fraud - costs the industry, and ultimately consumers, R13-billion annually.
This is according to the latest finding of The Southern African Fraud Prevention Service (SAFPS).
Executive manager of SAFPS Manie van Schalkwyk said both consumers and the healthcare sector can help in the fight against medical aid and other healthcare fraud.
He said at least 7% of medical aid claims are fraudulent and the figure might be as high as 15%.
"Approximately R130-billion a year is spent in the private healthcare sector in South Africa and if 10% of claims are fraudulent, it means fraud costs us R13-billion per annum," he said.
He defined healthcare fraud as dishonest consumers, such as medical aid members or service provider suppliers of medical equipment and medical professionals, who claim or submit false or misleading information to increase payments or reduce their own payments due.
Van Schalkwyk said healthcare fraud impacts on everyone - from suppliers of healthcare goods to healthcare service providers and medical aid members.
He said most medical aid members do not deliberately perpetrate fraudulent activities. However, even a small percentage of fraudsters impacts negatively on the cost of healthcare benefits for all. Some examples of consumer fraud include:
lUsing someone else's medical aid details or medical aid card, or filing claims for goods, services or medications not received;
lForging or altering invoices or receipts in collaboration with a healthcare service provider, agreeing to invoice services not actually performed and then sharing the payout; and
lConspiring with service providers to misrepresent procedures performed to obtain payment for non-covered services, such as cosmetic surgery.
You can help prevent healthcare fraud by inquiring about the service that you receive, the reason for the service and all the costs involved.
Be vigilant when you receive promotions offering free tests, treatments or services, especially when the provider requires a copy of your medical aid details.
Keep your medical aid information confidential and
report suspected fraud to the Board of Healthcare Funders of South Africa (BHF) at 011-537-0200.
SAFPS is a nonprofit organisation committed to fighting fraud and offering South Africans a means of protecting themselves against impersonation and identity theft. It can be contacted on 011-867-2234 or email@example.com