Stop fraud in its tracks

Fraud is a growing problem which negatively affects medical schemes and members.  It leads to increased member contributions and reduced reserves, placing entire medical schemes and members at risk.

GEMS is fully committed to protecting our members and we follow a zero tolerance approach to medical scheme fraud. The Scheme has invested in sophisticated technology and has the forensic expertise to uncover cases of fraud, but it also needs the help of its members if it is to continue effectively dealing with this problem.

We encourage members to report all instances of fraud and abuse. The Scheme promises to thoroughly investigate each allegation and bring those guilty of fraud to book. GEMS will take action against anyone who tries to defraud the Scheme including members, healthcare professionals, GEMS employees and other stakeholders. Those members who are found to have defrauded the Scheme may lose their membership, lose their subsidy and even be prosecuted.

Many members seem to wrongly assume that it is within their rights to get the most out of their medical scheme by being dishonest. For example, they think: "So what if I get a designer pair of sunglasses paid by my scheme once in a while?" or "GEMS will not know if I use my medical scheme card for a friend to obtain free benefits". These activities are fraudulent and are crimes punishable by law. GEMS cautions against fraudulent activity and encourages members to join the Scheme in the fight against this scourge.

GEMS has a confidential, toll-free 24-hour hotline where you can anonymously report all instances of fraud without fear. Those who encounter any form of fraud are encouraged to call 0800 21 22 02 or report the incident to the Fraud Services Manager, KPMG Hotpost BNT371, PO Box 14671, Sinoville, 0129.