Bonitas Member Magazine 2018 - B-Living Issue 1 | Page 19

The majority of healthcare providers implicated in the reported criminal cases are speech therapists and audiologists. Therefore, we are currently enhancing our efforts to ensure due diligence on claims regarding this discipline. Four of the convicted healthcare providers are medical technologists from Limpopo who submitted false claims for services that were never delivered. They were charged with 180 counts of fraud, which was made up of 21 171 claims. Bonitas is constantly engaging with the police and the crime unit to ensure progress on these cases. 601 interventions were initiated by healthcare providers Steps were taken to recover the money Bonitas paid out to these providers as a result of their fraudulent behaviour. Various measures were taken against healthcare providers who failed to honour the repayment terms. This included internal controls that were introduced to identify healthcare providers who evaded the sanctions imposed. One healthcare provider, practicing as a general practitioner, was also found guilty of fraud after he pleaded guilty to the charges against him. This healthcare provider was also submitting claims to Bonitas members for services not rendered and using a locum that was not registered with the Health Professions Council of South Africa. The provider was sentenced to five years imprisonment, which was suspended, and a fine of R185 000 payable to Bonitas by 31 January 2018. In addition, 52 healthcare providers were reported to the Health Professions Council of South Africa. In 2017, we updated our forensic detection software to detect irregular claims at pharmacies as well This increased the identification and confirmation of fraud, waste and abuse to a total of over 601 healthcare providers. These interventions further increased the amount of the identified fraud, waste and abuse by 40%. Recoveries also increased significantly by 85%. It also resulted in a positive change in claiming patterns from healthcare providers. This behaviour change has been quantified to an amount of R75 million as of September 2017. Successes did not come without challenges One of t