Red flags to help you identify a fraudulent healthcare provider

White collar criminals use deceit, dishonesty and disguise to gain business or personal financial advantage. It is unfortunate that among our dedicated healthcare providers there are some who engage in fraudulent activities.

Some healthcare providers defraud the Scheme and its members by:

• Billing for services that were never rendered during a consultation
• Prescribing unnecessary tests and treatments to patients
• Exaggerating a patient's medical condition
• Billing for non-medical supplies against medical codes
• Gaining access to GEMS Wellness events at which they conduct screenings that they unlawfully bill the member for (services offered to you at GEMS Wellness Days are for free and you
  shouldn't be billed for these services).

If you suspect that your healthcare provider is prescribing unnecessary tests, treatment and medicine that could ultimately worsen a patient's health, immediately report this matter to the Scheme by:

• Calling the anonymous 24 hour toll free GEMS Fraud Hotline on 0800 21 22 02
• You can also send an email to [email protected]
• Send a fax to 086 726 1681, or
• Information can also be posted to: The Fraud Services Manager,
• PO Box 21076, Valhalla, 0137.

Always be alert to detect fraudulent healthcare provider behaviour.