Fraudulent Medical claims amount to billions

Legalbrief Today reported on a statement by Discovery Health’s CEO, Dr Jonathan Broomberg, that fraud in the medical schemes industry is estimated to cost SA between R8.22bn and R43.2bn.

One of the latest scams to hit Discovery comes from syndicates who target hospital cash plans.

“Broomberg said doctors were admitting patients, who were not ill, to hospital, and then submitting false claims on their behalf to both their medical scheme and their cash plan provider. The ‘patient’ would then split the cash lump sum paid out by the insurer with the doctors and their partners in crime. Providers of hospital cash plans and Discovery were sharing data and scrutinising the claims submitted by medical scheme members who also had cash plans much more closely, he said.”

According to a report in Business Day Live, Broomberg said schemes had terminated the memberships of patients involved in this kind of scam and reported doctors to the Health Professions Council of SA.”

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