An eye-popping R30bn – or 15% of total revenue – is being lost by medical aids to fraud, waste and system abuse every year, heard the Healthcare Fraud, Waste and Abuse Indaba in Johannesburg last week.
The event, organised by the Board of Healthcare Funders (BHF) and the Healthcare Forensic Management Unit, served as a platform for industry leaders, healthcare professionals, and stakeholders to converge and address the pressing challenges posed by fraud, waste, and abuse in the private healthcare sector. The event ran parallel to International Fraud Awareness week.
Dr Katlego Mothudi, managing director of the BHF, said: “The actual fraud component is about R13bn. One of the schemes told us a developer helped someone buy a house using funds from their medical aid.”
Fraud, waste and abuse don’t only cause difficulties for medical schemes, said guest speaker former Public Protector Professor Thuli Madonsela, but make medical aids unaffordable for consumers.
“Exorbitant increases make it difficult for people to afford premiums. The majority of unethical conduct charged against doctors involves fraud,” she said.
As of 2022, only 15.8% of the population belonged to a medical aid scheme, reports News24.
Madonsela said fraud was being committed by healthcare providers in multiple ways, the most common being false claims and irregular billing of quotes. Additionally, generic medicine was being billed as original.
News24 article – Medical schemes lose R30 billion a year to fraud, conference hears (Open access)
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