Medical aids often their own worst enemies with fraud

Abstract

Less than a third of medical schemes in South Africa (29.4%) use estimates of their losses to fraud, waste and abuse to decide how much they will invest in countering these practices. Most try to negotiate with offenders to mitigate their losses, making countrywide quantification almost impossible, while individual schemes fail to collaborate sufficiently, enabling crooked syndicates and individuals to move between schemes with virtual impunity. Only a minority, (also 29.4%), of schemes ensure that the people they hire to counter these practices have received professional training and accreditation for their roles.