According to a recent report at least 10% to 15% of all claims made to healthcare providers are fraudulent. This adds up to billions of rands which has a profound negative impact on both members and the schemes they’re signed up with.
Here are a few examples of healthcare fraud and abuse:
Tauhir Manuel, Chief Executive Officer at GetSavvi Health, explains that healthcare fraud is a very complex form of financial fraud. He says that it can involve and be committed by a combination of members, healthcare professionals, healthcare service providers and brokers.
Manuel says that these types of abuse and fraud generally have two impacts.
“For healthcare schemes it increases costs, not only from a claims paid, but also from a human capital perspective as institutions are forced to increase their employee base with specialists to identify and combat fraud.”
He goes on to explain that from a member’s perspective an increase in claim costs forces an organisation to increase premiums which negatively impacts the consumer/member’s pocket.
“At GetSavvi Health we try to proactively identify fraud. It’s for this reason that we sms our members whenever we receive a claim from a provider,” Manual explains.
He further implores GetSavvi Health members to be vigilant when receiving these communications and to ensure that claims being made against their membership number are due to services rendered and not fraudulent transactions.
Manuel further stresses that, in addition to this, it’s important for members to give feedback in relation to their doctors’ visits.
“If they feel that a provider is calling them continuously for the same issues and does not address the issues properly, they should inform us so that we can have a conversation with the doctor to try to ensure ‘first-time fixes’ for our members.”
GetSavvi Health members are welcome to contact us at firstname.lastname@example.org or contact our call centre on 0861 18 92 02 if they suspect fraud.
Members also have the option of reporting fraud to the Board of Healthcare Funders or the Health Professionals Council of South Africa.