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 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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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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10 reasons why medical malpractice is threatening SA healthcare

According to an Econex survey commissioned by the Hospital Association of South Africa (Hasa) in 2015, there were just 60 doctors per 100,000 people in 2013; whereas the world average is 152. The emigration of healthcare professionals adds to South Africa’s doctor shortage – a situation which is placing the country’s entire healthcare system at […]
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So kies jy die regte mediese plan vir jou

Hospitaalplanne, omvattende dekking, netwerkopsies . . . Besluit watter opsie vir jou die beste is. As jy lid is van ’n mediese fonds, het jy tot 15 Desember kans om jou voordeleopsie vir 2018 te verander. Oorweeg jou gesin se omstandighede: Hoeveel is julle; hoe is jul gesondheid; wat kan jy bekostig? Besluit dan watter […]
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Mediese selfbetalings styg met skokkende 13,4%

Die brood het gekrimp, maar ons betaal nou meer daarvoor. Só het ’n ekonoom die verhoging van meer as 13% in selfbetalings deur mediesefondslede die afgelope jaar beskryf. Verbruikers wat elke jaar swaar trek aan die premies vir hul mediese fondse het boonop nog verlede jaar R29,7 miljard uit hul eie sak opgedok. Dit is […]
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Health Professions Council of SA pursues bogus health practitioners

A rise in bogus health practitioners has forced the Health Professions Council of SA (HPCSA) and medical schemes to strengthen their forensics units to curb fraud. A team at the HPCSA is conducting about 400 investigations into bogus practitioners. To date, just more than 40 arrests have been made, but prosecutions are slow. Data from […]
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Syndicates and devious health professionals may target National Health Insurance

Criminal networks are targeting your medical aid rands but could you be part of the problem too? Criminal syndicates and unscrupulous doctors may be defrauding the private health sector of millions as experts warn that medical schemes may reach a breaking point. “The health care sector is being targeted by criminal syndicates and even devious […]
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Skok-voorbeelde van bedrog by mediese fondse aan die lig gekom

Die gesondheidsorgbedryf is in die visier van misdaadsindikate en onderduimse praktisyns. Dr. Gregory Pratt, mediese adviseur vir forensiese ondersoeke in die gesondheidsbedryf vir Medscheme, het op die beraad vir gesondheidsorgfinansiers in Kaapstad skokkende voorbeelde genoem van bedrog waarmee hy die afgelope maande te make gehad het. Mediese bedrog is so algemeen “omdat dit makliker gepleeg […]
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Pryse vir kankermedikasie word ondersoek

Suid-Afrikaanse kankerpasiënte en hul geliefdes het die mededingingskommissie se besluit om drie farmaseutiese maatskappy se pryse vir kankermedisyne te ondersoek geloof, en versoek dat die ondersoek so spoedig moontlik afgehandel moet word. Die mededingingskommissie het vroeër die week aangekondig dat hulle die internasionale farmaseutiese reuse Aspen, Pfizer en Roch ondersoek omdat die maatskappye na bewering […]
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