The above examples confirm that we are under siege, and put to bed allegations by Sowetan columnist Palesa Lebitse in her July 2 article head-lined: "Supposed watchdog lets medical aid schemes go rogue with impunity."
According to the Board of Healthcare Funders, at least 10% to 15% of all medical aid claims are fraudulent, a substantial expense in a R150bn industry.
According to the Association of Certified Fraud Examiners, the world's largest anti-fraud organisation, the 10 most common healthcare provider fraud schemes are:
. billing for services not rendered,
. billing for a non-covered service as a covered service,
. misrepresenting dates of service,
. misrepresenting locations of service,
. misrepresenting provider of service,
. incorrect reporting of diagnoses or procedures,
. over-utilisation of services,
. corruption (kickbacks and bribery),
. false issuance of prescription drugs.