Help us fight medical aid fraud
Healthcare fraud , waste and abuse – in all its forms - is prevalent in both the public and private healthcare industries and , the sad reality is that it is becoming more organised . We need to work together to put a stop to this corrupt practice as ultimately it impacts on all taxpayers as well as medical aid members .
The good news is that the vast majority of healthcare providers are caring , dedicated professionals with integrity , whose top priority is the well-being of their patients . Healthcare claims , submitted by healthcare providers and members , are paid in good faith by medical aid schemes to ensure that members will always have access to the critical medicine , surgeries and other procedures they need , when they need it .
Fraud , Waste and Abuse ( FWA ) in the healthcare industry is often difficult to detect . It comes in many guises – from under or over charging for services through to ‘ billing ’ or claiming for procedures or medications never received . The perpetrators are also widespread and can include doctors , therapists , hospitals , pharmacists , suppliers or medical aid members , medical aid employees and consumers .
There are many examples of FWA , including : Medicines dispensed without a prescription or without the pharmacy being in possession of
20
Bonitas Member Magazine Issue 2 | 2022