Loading...
See More

SA medical aid fraud decreasing - survey

Jan 10 2012 14:53 Sapa

Related Articles

Court ruling keeps basic medical aid cover

Medical aid fees to guide NHI payments

CMS: Not enough private hospital choice

Gems covers mostly first-time members

Consumer commission eyes medical schemes

Hawks probe medical aid racket

 
Johannesburg - The number of fraud cases in the medical aid industry has decreased, according to a survey by KPMG.

The Medical Schemes' Anti-Fraud Survey, which covered the three years from 2007 to 2009, showed the fraud-to-claims ratio had fallen by 0.15%, said national forensic director for healthcare Camilla Singh.

"We can clearly see the ratio of investigated fraud to claims is dropping. This is an achievement for South Africa's medical aid administrators," said Singh.

The survey was sent to 15 administrators and the eight respondents represented 84% of all principal members. Medical schemes which participated in the survey included Discovery, Medscheme, Metropolitan and Momentum, said Singh.

She said the survey showed that the number of fraudulent claims by members was also at a low. This amounted to R67.3m out of a claim value of R145bn over the three-year period.

The most common reason given for member fraud was non-disclosure of prior ailments. This amounted to about 92% of all cases, said Singh.

However, service provider fraud was increasing. Code manipulation was the most common type investigated, followed by services not rendered, Singh said.

"There has been a definite crackdown on fraud in this industry in the last decade."

In KPMG's 2001 to 2003 survey, only 49% of medical aid administrators said they never kept quiet about fraud cases, said Singh.

By 2009, this had risen to 100%.
private healthcare  |  nhi  |  healthcare costs
NEXT ON FIN24X

 

Lastest Articles

Here is how to check your credit score and manage it Read More...
Top tips to save money over the festive period Read More...
These are the top 5 most fuel efficient cars in SA Read More...
What to consider when switching medical aid schemes Read More...
 
 

Read Fin24’s Comments Policy

24.com publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
2 comments
Add your comment
Comment 0 characters remaining
 

Company Snapshot

Brought to you by BizNews

More from BizNews

We're talking about:

Small Business

Retailers of any shape and size can now unlock the power of mobile transacting.
 

Money Clinic

Money Clinic
Do you have a question about your finances? We'll get an expert opinion.
Click here...
Loading...