Members in the know
While we ensure that healthcare providers act ethically, a critical focus in combatting fraud is educating members.
The Group Forensics team gets invited to attend scheme open days and wellness events, where they interact with members face-to-face to get into the nitty gritty of what’s happening out there and at the same time, get to educate them on Fraud, Waste, Abuse and Error (FWAE) and what to be on the lookout for.
In the first quarter of this year, the team met over 2 000 members across various schemes. The direct interaction was priceless and this was evident in the questions members asked, and also the information they shared with us.
“It’s so rewarding when members express how happy they are that we have come out to meet and speak to them personally, to educate them on things they may not have known, and where they do know, to elaborate and show them how and where to access information – and, very importantly, how to report incidents that are irregular,” the team said
Sharing knowledge
Some of the pointers Group Forensics shared with members were:
- Ensure contact information is up to date with the medical aid scheme.
- Take note of SMS or email notifications relating to claims.
- Be aware of the claims submitted on their medical aid.
- Read and understand their member statements.
- Read notifications received pertaining to fraud-related tips.
- Look out for suspicious activities between members and providers.
- Details on how to report activities deemed to be suspicious or false.
The team also gave members a few tips to avoid getting scammed:
- Double-check everything
- Don’t click on suspicious links
- Use multi-factor authentication
- Be cautious with personal data
