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.
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

Kundiges in gesondheidsbedryf krap kop oor toename in hospitalisasie

Kundiges in die gesondheidsbedryf het op die jaarlikse konferensie van die Hospitaalvereniging van Suid-Afrika (Hasa) in Kaapstad hewig van mekaar verskil oor wat die redes vir ‘n skerp toename in die koste van mediese skemas is. Matthew Prior, hoof van gesondheidsbeleid van Life Healtcare, sê ’n toename in benutting van gesondheidsdienste word die afgelope jare […]
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

Why opting out for a cheaper medical cover can cost you in the long run

Medical cover is expensive, and getting more so every year. Unfortunately this could mean we opt for lower monthly premiums that could mean you aren’t covered in the event of an expensive procedure. The South African Society of Anaesthesiologists (SASA) is advising South Africans to consider the multiple factors affecting cover when choosing access to […]
Continue reading…

Enjoyed this post? Share it!

 
 

Are Medical Scheme Members aware of what they are paying for?

The medical scheme industry is full of jargon and benefit structures that often leave the man on the street confused and frustrated when it comes to understanding and accessing their benefits. Medical schemes have in recent times attempted to simplify terminology to make it more understandable, but are they doing enough to ensure members know […]
Continue reading…

Enjoyed this post? Share it!