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!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

Bejaarde man wat 15 dae lank op ’n noodoperasie gewag het, sterf

Die Vrystaatse gesondheidsdepartement ontken enige aandadigheid aan die dood van ’n pasiënt wat 15 dae lank op ’n noodoperasie gewag het. Frederick Thiart (77) van Edenburg is 14 Desember dood, twee dae nadat sy been geamputeer is. Thiart, ’n diabeet, het met erge pyn en gangreen in sy een been in die Pelonomi-hospitaal in Bloemfontein […]
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!

 
 

Durban government hospitals are a shambles

Four Durban public hospitals -Prince Mshiyeni Memorial, Mahatma Gandhi, Addington and King Edward VIII – are ailing, with some critical management positions occupied by people with no relevant qualifications. This was revealed in a damning report by a Ministerial Task Team which was set up by Health Minister Dr Aaron Motsoaledi to investigate these facilities […]
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

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 […]
Continue reading…

Enjoyed this post? Share it!

 
 

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. […]
Continue reading…

Enjoyed this post? Share it!