Survey shows medical aid fraud declining

The number of fraud cases in the medical aid industry has decreased, according to a survey by KPMG.

The Medical Schemes’ Anti-Fraud Survey, which covered the three years from 2007 to 2009, showed that the fraud-to-claims ratio had fallen by 0.15%, said national forensic director for healthcare Camilla Singh.

“We can clearly see the ratio of investigated fraud to claims is dropping. This is an achievement for South Africa’s medical aid administrators,” said Singh.

The survey was sent to 15 administrators and the eight respondents represented 84% of all principal members.

Medical schemes which participated in the survey included Discovery, Medscheme, Metropolitan and Momentum, said Singh.


She said the survey showed that the number of fraudulent claims by members was also at a low, which amounted to R67.3-million out of a claim value of R145-billion over the three-year period.

The most common reason given for member fraud was non-disclosure of prior ailments. This amounted to about 92% of all cases, said Singh.

But service provider fraud was increasing. Code manipulation was the most common type investigated, followed by services not rendered, Singh said.

“There has been a definite crackdown on fraud in this industry in the last decade.”

In KPMG’s 2001 to 2003 survey, only 49% of medical aid administrators said they never said anything about fraud cases, said Singh.

By 2009, this had risen to 100%. — Sapa

Subscribe to the M&G

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years, and we’ve survived right from day one thanks to the support of readers who value fiercely independent journalism that is beholden to no-one. To help us continue for another 35 future years with the same proud values, please consider taking out a subscription.

Related stories

Khaya Sithole: The decline and fall of the South African auditing profession

Its reputation is not being helped at all by the crisis at its independent regulatory body

Slice of life: How my mom taught me to save

In high school I used to be that guy who put together events such as the Valentine’s Day bash, as well...

Editorial: The Western enablers of global corruption

The Luanda Leaks, publicised late on Sunday evening, have vividly outlined the scale of the business empire of Isabel dos Santos, daughter...

Workers’ R60m ‘lost’ in banks scam

An asset manager, VBS Mutual Bank and a Namibian bank have put the retirement funds of 26 000 municipal workers in South Africa at risk

2019: The ones who left us

From Uyinene Mrwetyana, Oliver Mtukudzi to Xolani Gwala, Mail & Guardian remembers those who have passed on

More battles ahead for domestic worker unions

Florence Sosiba, speaks to the Mail & Guardian about how important domestic workers are and exclusion in the COIDA
Advertising

Subscribers only

Q&A Sessions: Frank Chikane on the rainbow where colours never...

Reverend Frank Chikane has just completed six years as the chairperson of the Kagiso Trust. He speaks about corruption, his children’s views and how churches can be mobilised

ANC: ‘We’re operating under conditions of anarchy’

In its latest policy documents, the ANC is self-critical and wants ‘consequence management’, yet it’s letting its members off the hook again

More top stories

Shabnim Ismail bowls her way into the record books Down...

The night before Australia’s Women’s Big Bash League (WBBL) final, fiery South African fast bowler Shabnim Ismail lay awake pondering how...

Hawks make arrest in matric maths paper leak

Themba Daniel Shikwambana, who works at a printing company, was granted bail and is due to return to court in January

Andile Lungisa: Early parole for the house of truth

Disgraced Nelson Mandela Bay councillor Andile Lungisa calls for a change of leadership in the ANC immediately after being released on parole

War of words at Zondo commission: ‘Grow up Mr Gordhan,...

The cross-examination of the public enterprises minister by Tom Moyane’s lawyers at the state capture inquiry went on well into overtime on Monday evening
Advertising

press releases

Loading latest Press Releases…