International Fraud Awareness Week, November 12-18th was initiated by the Association of Certified Fraud Examiners, where hundreds of organisations around the world come together and pledge to spread fraud awareness in their companies and their communities. Many South African Companies and Medical Schemes are actively part of that pledge.

At Aquilla Financial Solutions we are actively involved in educating and encouraging our clients not to commit fraud and create fraud awareness, especially within the medical scheme claims area. 

Did you know that healthcare fraud can contribute directly and indirectly to the rise of your medical costs, including your membership contributions? You, as a member or a service provider, have the power to help us prevent fraud for the greater good of all medical scheme members and providers.

What are common examples of medical aid fraud?:

  • Falsified or altered invoices.
  • Member and healthcare provider conspiring to submit false claims and sharing the money paid by the Scheme.
  • Members use their membership for individuals who are not dependents.
  • Claiming for original medication but dispensing generic substitutes.
  • Claiming for unnecessary services.

You might ask how you can help.  There are a number of things that you and I can do:

  • Check your claim statements carefully and ensure that you received the services that the service provider is claiming. Be aware that some providers might use your medical scheme details to submit false claims. 
  • Ensure that your membership card and number are protected at all times. For some criminals, it might be like an ATM card.
  • Don’t accept cash from a service provider in exchange for a medical aid claim. The changes are good in that they will put through a highly inflated claim to get back their cash

I want to encourage you to make use of any of the medical schemes' dedicated Whistleblower hotlines reporting channels to report any suspected medical aid fraud.

You are welcome to contact me if you want advice on your decision to change your medical scheme. We can do no-obligation comparisons for you between your different scheme options or between different medical schemes.

Remember that you have to make your option changes before the medical scheme due date.