The high cost of fraud
Gerda Strydom, General Manager at Medscheme Forensics, outlines the scale at which fraud is crippling SA’s healthcare system – and what the medical scheme industry and its members can do about it.
Fraud is a colossal, widespread problem, but never does it feel more personal than when it is undermining the wellbeing and good health of our own people. Every R1 lost due to fraud, waste or abuse adds to the ever-increasing member contributions for medical aids.
Even after all we have been through these past few years with Covid-19, and after healthcare finally became a priority in the eyes of the country and the world, the sector still loses about R22 billion a year due to fraud, waste and abuse.
This is why Medscheme drives awareness to ensure that South Africans stand up and ‘fight for what is right’ – the theme for this year’s International Fraud Awareness Week, which took place from 13-19 November.
As the largest health risk management services provider in the country, with nearly four million lives under its care, Medscheme took part in observing International Fraud Awareness Week. Initiatives included providing its schemes with content to share with their members on various platforms, such as SMS, scheme websites, Facebook, LinkedIn and videos shared at scheme roadshows.
Click here to see our very own discuss fraud at the roundtable, currently streaming on YouTube and LinkedIn.
Internally, Medscheme increased awareness with a series of videos, focusing on what fraud means to every one of us, how to recognise a fraudster, the impact that weaknesses in internal controls can have, and the importance of whistleblowing. Click here to see another of our initiatives to drive this awareness.
Medical scheme members can help tackle fraud by:
- Being aware
- Checking their claim statements carefully and ensuring they received the services their service provider is claiming
- Making sure their membership card and number are protected
- Not accepting cash from a service provider in exchange for a medical aid claim
- Reporting suspicious behaviour.
