Taking a Stand Against Healthcare Fraud for the Health of the Citizen
Johannesburg, June 27, 2023
Following the release of the Section 59 Investigation Preliminary Report in 2021, The BHF recognises that fraud, waste, abuse, and Corruption continue severely to impact the healthcare sector. The sector and all stakeholders must be aligned in purpose and do not engage in activities that may undermine the goal to eradicate this scourge.
The various boards of trustees that run medical schemes on behalf of their members remain dedicated to protecting the funds entrusted to them by health citizens and ensuring the effective management and protection of those funds.
Healthcare fraud, waste, and abuse pose significant risks to medical schemes and their members and the overall integrity of the healthcare system. The financial burden of fraud and irregular practises in the private healthcare sector is substantial. In South Africa, according to Council of Medical Schemes, it is estimated that such practises add approximately R22 billion per year to the overall cost of private healthcare. This additional cost must be covered by all members of medical schemes, resulting in increased premiums or reduced benefits for everyone.
Healthcare fraud can be committed in various ways, involving activities that range from submitting false claims to overbilling, providing unnecessary services or treatments, identity theft, and collusion between members and service providers.
The long-term consequences of healthcare fraud, waste, and abuse are substantial. Diverting resources to fraudulent activities undermines the availability and quality of essential healthcare services, putting patient safety at risk. Moreover, fraudulent practises drive up healthcare costs, resulting in higher premiums for all members.
While the majority of practitioners are honest, a small number engage in fraudulent activities. Ordinary people who commit fraud frequently do so because the environment is favourable to such behaviour. As medical scheme boards of trustees are responsible for ensuring the effective management and protection of the funds entrusted to them by the health citizen, they have implemented robust systems and protocols to prevent, detect, and investigate fraudulent activities within the healthcare system. Through collaboration with law enforcement agencies, industry stakeholders, and the health sector, we strive to create a healthcare environment that is transparent, ethical, and focused on delivering optimal care.
We urge all citizens to remain vigilant and report any suspected instances of fraud, waste, or abuse they may encounter. By working together, we can prioritise integrity, affordability, and the well-being of our members within the healthcare system.
For more information or to report suspected fraud, waste, or abuse, please contact our anonymous tips hotline at 080 847 4368.
