Fraud is a crime!
Wherever it’s found, fraud costs more than just the money. Like a stone dropped into a pond, the effects of fraud and corruption in a healthcare system can send ripples outwards, nudging everything in its wake, from costs and resources.
Did you know that Fraud affects your Medical Aid Benefits?
Surveys done have shown that almost 10% of monthly contributions go towards payment of fraudulent claims, which then results in higher contributions and diminished benefits.
The surveys also revealed that members are responsible for a bigger part of the fraud and at times in collusion with Providers.
What are the common types of fraud in the health insurance sector?
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- Performing medically unnecessary surgeries or treatments to generate higher insurance payments
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- Accepting kickbacks for patient referrals
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- Falsifying tests to justify unnecessary medical actions
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- Billing insurers for services that were not rendered, or padding claims with charges for procedures that did not take place
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- Upcoding, which is the act of billing for more expensive services or procedures than were actually performed
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- Unbundling, which is the act of billing each step of a procedure as an individual procedure
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- Misrepresenting non-covered treatments
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- Waiving patient payments (co-pays or deductibles) and charging these costs to the insurer or benefit plan
What are members supposed to do to protect their benefits:
- Keep your health insurance and personal information protected.
- Be informed about your role as a patient or insurance consumer, and don’t be afraid to question your healthcare provider about procedures or billing items you don’t understand.
- Seek out an independent opinion about treatments or care if you need it.
- Be responsible for your own healthcare and treatment, and seek services from an appropriate source.
- Report fraud if you come across it.
- Make sure you know what you are signing for before you put your signature or your finger on a biometric finger print reader.
Remember it is your money, your Medical Aid benefits, therefore do all you can to protect it.
If you suspect fraud, irregular or unethical practices, you can report it by contacting us on:
Tel: 086 7700 9165
Email: [email protected]
What you are doing is good l. We really appreciate that.