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Fraud Zone
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GEMS urges all members and potential members to be vigilant of the many scams that circulate within the healthcare industry and not to become a victim of fraud/ scams when applying for GEMS membership.
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The Health Professions Council of South Africa (HPCSA) is again urging prospective students to only study at accredited training institutions. This comes after the council discovered fraudulent emergency care certificates were issued by an unaccredited institution.
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The Board of Healthcare Funders of Southern Africa (BHF) estimates that medical schemes lose R22 billion a year to fraud. During the BHF annual conference, actuaries estimated that medical fraud made up as much as 15 percent of medical schemes' expenditure a year. The Health Monitor Company, which probed fraud in the medical industry, found one neurologist in KwaZulu-Natal whose admissions were emergencies 98 percent of the time.
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Medical aid fraud, theft and shoddy treatment of patients seem to be on the increase among doctors if the Health Professions Council of South Africa's misconduct figures are anything to go by. The council said that of about 3 000 complaints received in the 12 months to the end of March, almost 120 had been referred to the police for investigation as the practitioners involved were not registered with the body. Of about 1 830 cases it considered, it finalised 734 during the financial year.
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Specialist medical doctors at Charlotte Maxeke Johannesburg Academic Hospital were among those implicated in looting public funds, costing the Gauteng government more than R100 million in unlawful overtime claims.
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Taxpayers paid more than R10 billion in overtime to more than 500 000 public servants in the past two years. The payments did not include their normal monthly salaries. Most of the overtime claims were recorded by the National Departments of Health and Education.
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If the abuse of hospital cash plans continues to escalate, life insurers may have to take tough measures to ensure the financial viability of these products. Association for Savings and Investment SA CEO Peter Dempsey said that the measures could include raising premiums, introducing standard cancellation clauses and even stopping hospital cash plans completely.
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The husband and wife team at the helm of Selfmed Medical Scheme have been suspended and are to face a disciplinary inquiry, following an interim out-of-court agreement reached by the Council for Medical Schemes and the Selfmed scheme.
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About 101 KwaZulu-Natal doctors have claimed more than R22m from a medical aid scheme for private work carried out at a time when they should have been attending to patients in state hospitals, the Sunday Tribune reported.
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Medical schemes continue to battle against fraudulent claims. In March, The Times reported that corrupt doctors, pharmacists, physiotherapists, radiologists and pathologists were ripping off medical schemes to the extent of about R22bn/year. The industry disputes the figure, saying correct estimates point to half that amount.
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No money or credit card is needed when shopping at South Africa's first cashless fashion boutique, The Exchange in Cavendish Square. All one has to do is to register as an organ donor with the Organ Donor Foundation in exchange for some high-end fashion and accessories from the country's top designers.
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HEALTH Minister Aaron Motsoaledi is turning to the taxman to help nab state doctors who ditch patients during business hours to work in private clinics, hospitals and practices. These public sector cheats are already being investigated by the National Health department and its provincial counterparts.
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Mrs Lebo Montshiwa of Mahikeng waited more than five years to see justice done and to do right by her medical scheme, GEMS.
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Corrupt doctors, pharmacists, physiotherapists, radiologists and pathologists are ripping off medical aids to the tune of R22-billion a year - resulting in members having to fork out thousands of rands more in premiums.
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The probe into private healthcare has been welcomed by dentists, who allege medical aid administration and broker commissions are driving soaring tariffs at a time when below-inflation payouts are putting them out of business.
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An inquiry into pricing and possible collusion in the healthcare market will begin on 1 April 2013 according to the Competition Commission.
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News that corrupt doctors and other healthcare practitioners are defrauding medical aid schemes of as much as R22 billion a year has met calls for action - from the DA to Cosatu.
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It is evident that the Medical Aid industry continues to be very much exposed to fraud and its related activities, although it is pleasing to note positive trends compared with previous surveys. The purpose of this survey, as with its predecessors, is to measure the response to fraud and to consider trends in terms of prevalence and frequency. It is our desire that the survey will serve as a tool in the fight against fraud.
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The Molope Regional Court sentences Tshegofatso Patricia Maubane owner of Omphemetse Pharmacy in Unit 9, Mahikeng to four years imprisonment and wholly suspended for three years. This was for the hundred and fourteen chatges of fraud against government employees medical scheme, GEMS, amounting to R26000 between December 2007 and February 2009.
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