CAPE TOWN - Bonitas says Phase 1 of their fraud detection initiative which ended in December 2016, has led to an identification of R79 million in fraud, waste and abuse.
In a statement, the scheme has expressed its gratitude for the work done by the South African Police Service and the Hawks to have successfully convicted and sentenced three bogus medical aid technologists in Limpopo, who milked the Scheme over R1 million.
Phase 1 of the fraud detection initiative was focusing on live billing. Now the scheme says they have introduced Phase 2 and 3 to focus on pharmacies and hospital claims.
Bonitas Medical Fund, Principal Officer, Gerhard Van Emmenis says, "Medical schemes are owned by their members and when the money is defrauded from the scheme it can contribute towards increased premiums".
Van Emmenis understands that their most invaluable tool against fraud, waste and abuse remains their members and urges the members to utilise every available resource and channels to report suspected fraud incidents.
The South African private healthcare industry estimates that around 10-15% of claims contain an element of fraudulent information.
- BUSINESS REPORT ONLINE