Fraud- one of the biggest challenges facing SA healthcare

Based on international studies, fraud in the medical schemes industry costs South Africa between an estimated R8.22 billion and R43.2 billion.

Fraud negatively affects healthcare costs and as a result, healthcare costs increase because there is a need to offset the funds lost to fraud. This results in higher premiums and reduced affordability for medical scheme members.

Last year alone, our Administrator (Discovery Health) recovered in excess of R280 million in funds. With the help of highly skilled professional investigators, the Administrator was able to investigate possible cases of fraud and prosecute the criminals responsible. This could not have been done without the help of healthcare professionals, healthcare funders, and - most importantly - members.

How you can help to overcome this challenge

Anglo Medical Scheme is committed to the fight against fraud and in protecting our members from it. You too can help us fight fraud:

• Keep track of your medical aid claim statements. This will help ensure your healthcare claims are valid.
• Ask for a copy of your claim to make sure the items or services you received are on it.
• Never give or lend your membership card to anyone who is not entitled to receive benefits on your membership. You risk losing your Medical Aid!
• Know your benefits so that you do not accept services or items the Scheme does not cover - which the provider offers to claim from the Scheme. Also, never allow the provider to claim for treatment that was never in fact given to you (in order to offset a co-payment).

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