Don’t get played
Medical aid fraud is not a victimless crime – it costs South Africa billions every year and every single member pays the price.
When fraudsters – whether healthcare providers, members or organised syndicates – game the system, the financial strain is passed on to every honest member through higher contributions and reduced benefits.
The Board of Healthcare Funders estimates that between 10% and 15% of all healthcare claims contain fraudulent, wasteful or abusive elements, costing the industry an estimated R28 billion to R30 billion a year. That’s money that should be going towards your care. By calling out fraud, you help keep contributions affordable and benefits intact for everyone.
Facing the consequences
If you’re caught committing medical aid fraud, you face:
- Immediate repayment of all fraudulent claims
- Termination of your medical aid membership
- Criminal charges and possible imprisonment of up to five years
- Reporting to the Health Professions Council of South Africa (HPCSA), if you’re a practitioner
Blow the whistle on fraud
