Izindaba

Medical aids often their own worst enemies with fraud

Chris Bateman

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.

Author's affiliations

Chris Bateman, Health and Medical Publishing Group, South Africa

Full Text

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Keywords

Medical aid schemes; Fraud; Board of Healthcare Funders; Healthcare Forensic Management Unit

Cite this article

South African Medical Journal 2015;105(11):887-888. DOI:10.7196/SAMJ.2015.v105i11.10197

Article History

Date submitted: 2015-10-13
Date published: 2015-10-16

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