Our Knowledge Corner

Fight against fraud

Fraud is the wilful misrepresentation of facts and/or any information to illegally obtain financial gain or benefit at the expense of someone else. While there are too many types of fraud to mention here, read on for a brief overview of this scourge.

Examples of healthcare fraud include:

  • Non-disclosure of existing or previous medical conditions
  • Falsified or altered invoices
  • Member and healthcare provider conspiring to submit false claims and share the refunds paid by the scheme
  • Members using their membership for individuals who are not dependants
  • Code manipulation – a healthcare provider using different billing codes to claim for a more expensive procedure from the scheme
  • Claiming for original medication but dispensing generic substitutes
  • Claiming for unnecessary services.

How can you help?

  • Check your claim statements carefully to ensure you have received the services that your service provider has claimed for.
  • Ensure that your membership card and number are safe and secure.
  • Don’t accept cash from a service provider in exchange for a medical aid claim.
  • Report suspicious behaviour immediately.

If you know about fraud, report it. The Fraud Prevention Hotline is always available to help you fight back against fraud, waste and abuse.

Remember that fraud causes all members’ medical aid contributions to increase. If you see it, you can report it anonymously and safely through these channels:

Together, we can fight for what’s right. Click here to see how fraud, waste, and abuse impact us all.

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