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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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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KPMG-skandaal raak ondersoek na duur medies

Private hospitaalgroepe maak beswaar daarteen dat KPMG die Mededingingskommissie met sy navorsing gehelp het. ’n Kompromis is nou bereik wat die hospitale toegang tot die navorsing gee. Die KPMG-skandaal pootjie nou ook die markondersoek na die private gesondheidsorg. Die voorlopige bevindinge van die ondersoek moes die afgelope week bekend gemaak word nadat dit verskeie kere […]
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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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What’s driving up our healthcare costs?

Discovery Health CEO explains why South Africans are paying higher medical aid premiums than ever before. Access to quality healthcare at an affordable price is a critical priority for every family, and in society at large. South Africans lucky enough to afford private healthcare have rapid and convenient access to some of the best quality […]
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Cancer treatment waiting times in KZN increase by almost 30% as services stall

Cancer patients are waiting up to nine months for treatment, says the South African Human Rights Commission. KwaZulu-Natal cancer patients are now waiting nine months for treatment, alleges Democratic Alliance spokesperson for health in KwaZulu-Natal Imran Keeka. In a statement, Keeka said South African Human Rights Commission (SAHRC) chairperson Bongani Majola revealed this new information […]
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Medical aid waiting periods and late-joiner penalties: What. How. Why?

The world of medical schemes in South Africa is a very different one to 25 years ago. There are strict rules and regulations governing the industry, there to protect both the members and the financial sustainability of the scheme. Now is the time of year when medical schemes announce their annual increases and benefit changes. […]
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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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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 […]
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#HASA2017: NHI needs to start delivering now

South Africa can’t wait for the final National Health Insurance (NHI) system in 2026 to start delivering on universal health coverage, but needs to start implementing projects and programmes that will make a real difference in people’s lives now. And this can’t be done without cooperation between the public and private health sectors. This was […]
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