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GPs, pharmacists top fraud list

Aug 18 2008 08:14

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Johannesburg - General practitioners (GPs) and pharmacists are the largest perpetrators of fraud, the latest KPMG Medical Schemes Anti-Fraud Survey has revealed, The Star newspaper reported on Monday.

KPMG forensic partner Camilla Singh said this was despite the fact that GPs and pharmacists represented only eight percent and 18% of claims respectively.

"Respondents to the survey indicated that the highest value of fraud had been perpetrated by GPs, at 29%.

"Pharmacies too demonstrate a similar trend, in that they represent 18% of claims paid out, but 28% of the fraud investigated," she said.

According to Singh, medical specialists followed the two, with 24% of claims but 26% of investigated claims.

"What has been interesting to note in this survey is that the hospitals have by far the biggest percentage of claims at 38%, yet the value of fraud investigated was only three percent, which seems to suggest a level of legitimacy in hospital claims," she said.

The survey also indicated a lack of confidence in the South African Police Service and the department of justice, the report read.

 
 
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