Tuesday, 25 June, 2024
HomeMedico-LegalSIU calls for tougher sanctions for health industry fraud

SIU calls for tougher sanctions for health industry fraud

The SIU is spearheading 70 cases before the courts and a special tribunal involving fraud in the health industry, according to SIU head and chairperson of the health sector anti-corruption forum Andy Mothibi, who added that the extent of fraud and abuse in the medical scheme industry was partly due to meek and mild penalties.

“The forum is lobbying for a review of the sanctions that are available,” he told Die Burger, according to a Legalbrief report.

While the SIU identified fraud amounting to R2.8bn in the 70 cases it is pursuing, the medical scheme industry estimates that fraud and waste amount to between R22bn and R28bn per annum.

This includes fraudulent claims for services rendered, provision of more expensive drugs where generics are available, duplication of claims, and incorrect diagnostic codes being used to maximise payouts from medical schemes.


Die Burger article – ‘Swaarder strawwe nodig om bedrog, korrupsie in mediese sektor te bekamp’ (Restricted access)


See more from MedicalBrief archives:


Fraud and abuse cost medical schemes R28bn a year


Blockchain ‘has potential to curb fraud’ in medical schemes


Medical schemes' anti-fraud tactics queried at CMS inquiry


Doctors and medical schemes clash over blame for fraud


HPCSA disciplinaries: Incompetent and unauthorised post-mortems and numerous counts of fraudulent medical aid claims








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