South Africa’s private healthcare sector is haemorrhaging up to R28 billion a year due to rampant fraud, waste, and abuse (FWA). This directly threatens the quality of care and financial stability of medical cover for millions of citizens. The stark warning comes from the Health Funders Association (HFA), which estimates the losses represent a staggering 15% to 20% of all…
Tag: Fraud
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Racial Bias Report: Are the Claims Valid?
A fuse has been lit in South Africa’s private healthcare industry following the release of a controversial racial bias report. It claims black healthcare providers are disproportionately targeted in fraud investigations. The Section 59 report, submitted to Health Minister Dr Aaron Motsoaledi, alleges systemic racial discrimination by medical schemes. However, leading industry bodies have hit back, labelling the racial bias…
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Gems Denies Racial Profiling in Investigations
The Government Employees Medical Scheme (GEMS) has told Parliament that it does not target black doctors based on their ethnicity during fraud investigations. In response to the allegations, Gems denies engaging in racial profiling against any of its practitioners. The assurance comes in the wake of a damning industry report. This report concluded that its systems were “procedurally unfair” and…