Hospitals hit by patient fraud

2009-06-02 10:19

Cape Town - Private hospitals are increasingly complaining about patients committing fraud, and forcing the hospitals to write off these debts.

Otto Wypkema, chief executive of the National Hospital Network, says managers of the group's private hospitals are seeing rising misrepresentation and fraud. "Private hospitals are having to absorb a great deal more bad debt," he comments.

According to Hennie Steenkamp, manager of the Wilmed Park Hospital in Klerksdorp, patients often profess to be dependent members of a medical scheme, or still belonging to a fund, while their membership has expired or is in arrears.

"A medical fund frequently authorises a procedure and then refuses to pay for it because that member's premiums are in arrears. The doctor or the hospital is ultimately not paid."

"It is then sometimes easier for us to pay a member's outstanding premiums of R7 000 of R8 000, rather than suffer a loss of R40 000 of R50 000."

Firoze Habib, spokesperson for the Louis Pasteur Hospital in Pretoria, says what also happens is that medical scheme members attempt to receive treatment after retrenchment of the main member. "We frequently receive authorisation from the funds, because their administration is not up to date, but they subsequently refuse to pay us.

"People will also come in over weekends when it is not always possible to obtain confirmation from the fund concerned."

Wypkema reckons the scrapping at the end of last year of the ethical tariff, or the maximum tariff a doctor may charge, as determined by the Health Professions Council, can contribute to more unpaid accounts. Patients are now required to agree to pay fees that are higher than those on the National Health Reference Price List.

"Private hospitals with emergency units cannot always expect patients to sign documents accepting their doctor's fee structures. This increases the risk of doctors treating emergency cases with the risk of not being paid," says Wypkema.


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