Loading...
See More

Clampdown on healthcare fraud

Jul 26 2012 11:04

Related Articles

Medical Schemes Act 'discriminates'

Commission: Medical schemes discriminate

Discovery defends admin fees

Members want probe into Discovery fee

Medical schemes sceptical about NHI

Nehawu criticises ‘self-enrichment’

 
Cape Town – The healthcare sector is losing between R4bn and R13bn every year through fraud, abuse and unethical behaviour, according to Liberty Medical Scheme (LMS) executive principal officer Andrew Edwards.

As many South Africans find it increasingly difficult to make ends meet, instances of fraud and abuse on all sides of the spectrum – from members, healthcare providers and employees to intermediaries, administrators and trustees – appear to be on the increase.

"The ultimate cost of healthcare fraud is felt the hardest by the scheme members, who pay the monthly contributions towards their medical cover," Edwards said.

According to him it is paramount for the healthcare sector to stringently monitor any suspicious conduct and claim, and act speedily and decisively to prevent the unnecessary loss of funds.

The most recent KPMG anti-fraud survey showed that member claims represented a relatively small amount of R67.3m out of a claim value of R145bn over the three-year period from 2007 to 2009.

Non-disclosure of prior ailments was the most common reason cited for member fraud.

The survey also found that service provider fraud was increasing, with code manipulation the most common type investigated. This was followed by services not rendered.

According to Edwards, LMS is taking a zero tolerance approach to fraud and abuse.

"A dedicated team of forensic specialists monitor, detect and investigate any instances of fraud or abuse at LMS and the team is strengthened by other clinical specialists in the business.

"Private healthcare fraud and abuse is a national problem affecting all of us, either directly or indirectly. This loss leads to increased costs for all stakeholders involved, everyone from funders and providers to medical scheme members.
 
"The ultimate cost of healthcare fraud, however, is felt the hardest by the scheme members, who pay the monthly contributions towards their medical cover," he said.

"By vigilantly monitoring fraudulent behaviour and acting swiftly to bring culprits to book, LMS has managed to recoup significant amounts of money, to the benefit of our members," Edwards said.
NEXT ON FIN24X

 
 
 

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
10 comments
Add your comment
Comment 0 characters remaining
 

Company Snapshot

We're talking about:

Small Business

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

Goalkeeper saves five penalties with his FACE!

Nothing, and we mean nothing, will keep goalkeeper Scott Stirling from stopping the ball!

 
 

Men24.com

Hottie of the day: Jesselyn
This invention makes farts smell like chocolate!
11 things men don’t know about their clothes
Hilarious mortal kombat elevator prank!

Money Clinic

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