Help us to protect your Scheme against Fraud
The Industry says up to 15% is lost to fraud. Help us to protect your Scheme against Fraud.
What can happen if fraud is proven?
- In the case of healthcare providers, the following sanctions may be imposed:
- Reversal of all irregular transactions (e.g. claims);
- Placing a provider on indirect payment;
- Reporting a provider to the relevant regulatory body;
- Recovery of losses through civil or criminal process;
- Proceeding with a criminal case; and
- Removal of the provider from any Scheme network for a period of 12 months.
- In the case of members, the following sanctions may be imposed:
- Termination of membership;
- Proceeding with a criminal case;
- Recovery of losses from the member; and
- Reporting the member to their employer.
- What can you do to protect your medical aid scheme against fraud?
- Scrutinising every SMS notification and statement received from your medical aid.
- Inform the Scheme of any transactions or procedure that you do not recognise.
- Tell us if your colleagues often boast about a bargain they came across (such as some miracle weight loss injection from a doctor) and that they did not pay a cent for it because the medical aid paid for it. If it sounds too good to be true it probably is. Report it to the scheme. We will investigate.
- Immediately report a lost medical aid card to the Scheme. A lost medical aid card can be equivalent to cash in the hands of the wrong people.