'Up to 15% of all medical claims are associated with fraud, waste and abuse'

According to the Council of Medical Schemes, abuse, waste and fraud in private healthcare are costing this sector billions annually.

The council says up to 25% of all premiums paid by medical aid members is spent funding these false claims, amounting to between R22 billion and R28 billion a year.

Read: Fraud on the rise in SA - and doctors are some of the biggest culprits

During the Fraud, Waste and Abuse Summit last week, the council says it paid R 172 billion in 2017 and 15 % of those claims were as a result of fraud, waste, and abuse.

Acting chief executive and registrar for medical schemes at the Council of Medical Schemes, Dr Sipho Kabane, says the purpose of the summit was to bring all role players together to agree on a set of principles and curb the scourge of fraud, waste, and abuse in the sector.

Contributors to this are very wide. You have doctors, physiotherapists, dentists and anybody that provides services to members of the schemes will fall into that group. It would be difficult to pin it down to one group.

Dr Sipho Kabane, Acting chief executive and registrar - Council of Medical Schemes

He adds that sometimes it is the members themselves that collude with service providers to commit these crimes.

Up to 15% of all claims are associated with fraud, waste and abuse.

Dr Sipho Kabane, Acting chief executive and registrar - Council of Medical Schemes

Listen below to the full interview:


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