The Board of Healthcare Funders has mentioned that 10% -15% claims are fraudulent or wasteful, and in 2017, Medscheme recieved 1500 tip offs and recovered R107 million which had been lost to fraudulent claims.
Chair of the Healthcare Forensic Management Unit Dr Hlei Nhlapo says that unfortunately this is the status in the healthcare space. He adds that members have little knowledge of their benefits and they end up doing all kinds of things.
Members will use their card and allow other service providers to charge for services that they didn’t receive.— Dr Hlei Nhlapo, chair of the healthcare forensic management unit
Dr Nhlapo says that members also borrow unregistered relatives their medical aid card which adds up.
Medical aid payments or premiums is a monthly premium so members see it as a grudge purpose. There is a self-entitlement that they feel they must get for paying that amount of money.— Dr Hlei Nhlapo, chair of the healthcare forensic management unit
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This article first appeared on CapeTalk : Medical aid fraud: members have little knowledge of benefits says Dr Nhlapo