CMS moves to rein in how medical schemes investigate fraud
Circular 10 introduces interim rules to standardise audits, investigations, and clawbacks as broader reforms are developed.
#claimsprocessing
CMS steps in as Discovery Health begins recovering pharmacy overpayments
Discovery Health is engaging affected members individually after a processing error led to some pharmacy claims being paid beyond Above Threshold Benefit limits during 2025.
South African insurers harness AI to spot risks sooner and serve clients better
From early-warning systems in liability cover to behaviour-based motor premiums, local insurers are adapting AI tools to South Africa’s unique risks.
Compensation Fund vs Netcare: High Court judgment exposes deep fault lines
The battle over the alleged dysfunctionality of the Compensation Fund’s CompEasy system raises urgent questions about policy, functionality, and fairness.
RAF makes noise while silence reigns on draft Road Accident Amendment Bill
Judgment is ‘forthcoming’ in the contempt of court case against the Road Accident Fund and its CEO, as Discovery Health seeks the enforcement of court rulings regarding unpaid claims.
