Discovery Health recovers R568m through fraud-control activities in 2017

According to Discovery Health CEO, Dr Jonathan Broomberg, efforts to curb fraud in the healthcare system resulted in R568m recovered on behalf of client schemes in 2017, compared to R405m in 2016. Further, fraud-control activities in which health professionals and others contemplating fraud desist from committing fraud in reaction to visible policing and action by Discovery Health, prevented additional fraud to the value of approximately R3bn over the last two years, adds Broomberg.

Discovery Health has invested substantially in fighting the scourge of healthcare fraud. Efforts include the deployment of a specialised team of over 100 analysts and professional investigators as well as a proprietary forensic software system that uses sophisticated algorithms to analyse claims data and identify any unusual claim patterns. Invaluable tip-offs from whistleblowers also help to identify fraud.
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Private Healthcare in SA – continued decline and a possible solution

We entered 2017 reeling from a series of double-digit medical insurance premium hikes. It was becoming clear that schemes are in trouble; undercut by unregulated, selective insurance products and forced into tighter and tighter modes of managing care delivered.

We were facing an affordability crisis then – that, without serious systematic change, schemes will be unable to derail their progression towards shrinking memberships and eventual collapse.

Moving into 2018, scheme’s reserves are under threat, memberships are stagnant and the system continues, for the most part, to tolerate overutilisation of hospital services while failing to invest in strengthening community-level care. Alternative fee models remain tentative and marginal, neither inspiring nor supporting any structural changes in the fragmented way healthcare services are delivered. In light of this, I predict the following for the coming year:
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Discovery Health recovers R568m through fraud-control activities in 2017

According to Discovery Health CEO, Dr Jonathan Broomberg, efforts to curb fraud in the healthcare system resulted in R568m recovered on behalf of client schemes in 2017, compared to R405m in 2016. Further, fraud-control activities in which health professionals and others contemplating fraud desist from committing fraud in reaction to visible policing and action by […]
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Private healthcare in SA – continued decline and a solution

We entered 2017 reeling from a series of double-digit medical insurance premium hikes. It was becoming clear that schemes are in trouble; undercut by unregulated, selective insurance products and forced into tighter and tighter modes of managing care delivered. We were facing an affordability crisis then – that, without serious systematic change, schemes will be […]
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Medical aids spying on doctors with hidden cameras – High Court claim

The National Healthcare Professionals Association of South Africa has filed papers in the Pretoria High Court accusing 19 medical aid schemes of spying on doctors and sneaking hidden cameras into their consulting rooms. The Sunday Times reported that medical aids are also allegedly holding back payments to doctors due to unproven misconduct. The association – […]
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ANC looks to axe medical aid tax credits, expand National Health Insurance

The ruling party says it’s time to get serious about funding and rolling out South Africa’s universal access to healthcare plan. Your medical aid tax credits could be back on the chopping block if a decision by the education and health subcommittee of the ANC’s national executive committee is anything to go by. The committee […]
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Is dental healthcare as affordable and accessible as it should be?

Oral health is essential to optimal overall health and minimising the probability of developing serious oral health conditions or infections in future. Yet, besides the fear factor, why are so many people reluctant to visit the dentist? “The underlying factors here include resources, socio-economic circumstances, accessibility and education.” “One of the biggest culprits for keeping […]
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When he won’t say yes to a condom, maybe you should say yes to this pill

This tablet can help to protect the country’s young women from contracting HIV. The sun begins to set as Alwande Khoza* returns home from her second clinic visit in just over a week. She lives in a student commune in a quiet Durban street. It’s a two-minute walk from the Steve Biko campus of Durban […]
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How to choose a medical aid plan

Are you thinking of switching medical aid options? If so, read this first. It’s that time of year again. Many major medical schemes have opened up brief, annual window periods in which members can change their plans. Clueless? Contact your medical aid to find out about specific deadlines. While cost is the first thing most […]
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Stay healthy on holiday

December and the annual migration down to the coast or overseas will soon be a reality for the majority of South Africans as the summer holiday shutdown begins. Most of us are vigilant about our preparations ahead of going away. We make sure our car has been serviced and also make arrangements for our animals […]
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