Johannesburg - The Board of Healthcare Funders has suspended payments to 147 service providers, mostly doctors, for various fraudulent activities believed to have cost medical aids millions of rands.
Marius Smit, the chairman of the board's forensic management unit, told Business Report yesterday that five of those were facing criminal charges. Two of those implicated were each facing about 200 offences.
"Our message is clear: there is no place for the perpetrators of fraud to hide and those found guilty will face the consequences," Smit said.
The offences ranged from service providers giving out cash to patients and submitting claims to medical schemes for goods, to billing medical schemes for services not rendered. They also included duplicate claims being submitted by different practitioners as well as overservicing and abuse of services.
Smit said all the cases had been reported to the Health Professions Council.
"We believe fraud within the medical fraternity costs the medical aid industry between R4 billion and R8 billion annually. We, however, need to stress that it is not only doctors who commit this fraud. You also have brokers and members of medical schemes taking part."
Since the launch of the forensic unit in August last year, 45 employees of various medical schemes had been dismissed for being involved in such activities, Smit said.
"Over and above taking such action, we have also listed such employees, thereby preventing them from being employed by another medical scheme."
During the same period, 144 members of medical schemes had been listed for offences.
"The purpose is to warn the medical aid they face the risk of having such people on board. Because of new legislation, no one can be refused the right to belong to a medical aid of their choice," he said.
The unit is a collaborative approach by 95 percent of medical aids to root out fraud within the industry. In doing this, a database of employees, service providers and members has been created.
"The purpose is to list perpetrators that are under investigation and share that information within the industry. Its advantage is to prevent duplication of work by medical aids," Smit said.
Heidi Kruger, the board's spokesperson, said: "The overall focus of the unit is to protect honest members and service providers.
"We also aim to change behaviour without having to catch every perpetrator. Part of the process is to rehabilitate the perpetrators because we want them to work with the industry."