Leading the fight against healthcare fraud


As you are aware, fraud, waste and abuse in the healthcare industry is one of the main drivers of healthcare inflation and the increase in claims costs. To assist in curbing the impact, we introduced advanced analytical software into the live claims environment last year.

Using this software, we were able to identify over R79 million in irregular claims in 2016 attributed to medical practitioners only. To date, we have recovered millions of rands which could be used to fund at least 57 000 more family practitioner consultations for members, or potentially be used to fund an additional 18 lung or liver transplants.

The model will now be extended to include all pharmacy and hospital claims. Preparations are underway to implement this into production in the coming weeks. As always, the greatest weapon in the fight against medical aid fraud is you. Please check your monthly member statements and report any unusual or suspicious claims by calling our Whistleblower Hotline on 0800 112 811. You can choose to remain anonymous.

We are confident that our intensified focus on curbing fraud, waste and abuse will ensure the financial sustainability and longevity of the Scheme and allow you to access to even richer healthcare benefits in the years to come. We look forward to actively implementing further strategies to ensure you continue to have access to affordable, quality healthcare.

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