Creating fraud awareness

Making people aware of Fraud, Waste and Abuse is a critical component of our comprehensive Fraud Management Programme. 

Medscheme Forensics is always keen to take up opportunities to reach medical scheme members, healthcare providers, members of the public and many other stakeholders, via radio, news articles, communication on many platforms to members, attending conferences with healthcare providers or even attending Scheme wellness days. 

The Board of Healthcare Funders has reported that 10-15% of medical claims submitted are either fraudulent, wasteful or abusive. Gerda Strydom, our General Manager for Healthcare Fraud and Abuse, was interviewed on Channel Africa to discuss fraud committed by members of medical aids as well as by healthcare providers.  

Listen to the full interview here.

The Daily Maverick also published an article about rising healthcare costs and what we can do about it. Read it here.

Medscheme Forensics continues to drive awareness because we believe in the value of what is known as the “sentinel effect”. This means that humans tend to improve their performance when they know their behaviour is being evaluated. We believe that when members and healthcare providers are aware that they are being “watched”, irregular claims submitted to our medical schemes will reduce.