Fraud, Waste, and Abuse impact us all

Fraud, Waste, and Abuse impact us all – when healthcare professionals or any person engages in healthcare fraud, waste, and abuse, it affects us all, as ultimately, it is the members collectively, who bear the brunt in the form of increased monthly contributions as schemes try to mitigate the effects of the losses suffered. It is society’s collective responsibility to report irregularities/cases of fraud, waste, and abuse.

Medscheme, a subsidiary of the AfroCentric Group, is the largest health risk management services provider and is among the leading medical scheme administrators in South Africa, with more than 3.8 million lives under management. It is said that fraud, waste, and abuse account for 3 – 15% of the global estimate of healthcare spent. (other sources note 5% - 20%) - R22bn - R28bn.

Fraud savings would include both direct recoveries (cash back in the bank) as well as drop-in billing behaviour (rehabilitation) of providers previously investigated.

Medscheme Forensics has calculated a saving exceeding R3billion in drop-in billing behaviour for schemes represented.
Direct savings exceed R800 million over the past 5 years.

#HealthierTogether

[conniebakkes]

Great clip explaining FWA in the healthcare industry👌; well done Medscheme Forensics!

[LeonFernandez-tn]

I am Leon Fernandez, I promise the scheme I never abuse the system, I am not aware of medical practioners abusing the scheme, I do not go to a Dr unless an emergency or no alternate source, I am more than pleased with the scheme, thank you