The South African Society of Physiotherapy has lost its legal challenge against medical scheme clawbacks. The High Court in Pretoria dismissed the society’s application to have Section 59(3) of the Medical Schemes Act declared unconstitutional and invalid. The judgment ends a five-year legal battle involving the Minister of Health, the Council for Medical Schemes and the country’s medical schemes. The…
Tag: healthcare fraud
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Fake Doctors In South Africa Pose Sophisticated Threat
The South African Medical Association (SAMA) has raised serious concerns over the growing number of fraudulent medical practitioners. The association warns that these individuals are becoming significantly harder to detect. According to SAMA, these fraudsters use increasingly sophisticated methods to impersonate qualified professionals. Their tactics include presenting forged qualifications and falsifying registration documents. In some extreme cases, they even assume…
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Bogus Doctors in focus as HPCSA Warns on Rising Fraud
The Health Professions Council of South Africa HPCSA is warning that unregistered practitioners are putting lives at risk. New cases of “bogus doctors” continue to surface. “If you’re in the hands of an unqualified person, you’re as well as dead,” says. The council is responsible for registering medical doctors and other health professionals. It also investigates complaints about practitioners practising…
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Healthcare Facilities Cheat Compliance Checks
The nation’s health standards watchdog has sounded the alarm over an increasingly common and deceptive practice. Healthcare establishments “borrow” medical equipment and essential documents from other facilities to pass inspections fraudulently. This “window dressing,” as facilities cheat compliance checks, is being driven by a rush to obtain certificates of compliance ahead of the nationwide rollout of the National Health Insurance…
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Medical Fraud: A Discussion on Race and Class
The long-awaited final report from the Section 59 inquiry has left more questions than answers regarding medical aid fraud in South Africa. The investigation, initiated by the Council for Medical Schemes (CMS) after complaints of racial bias from healthcare providers, found that while fraud detection methods were fair, black practitioners were disproportionately found guilty of fraud, waste, and abuse (FWA).…
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Healthcare Fraud: 324 Charged in Major US Bust
The US Justice Department has announced that it has halted a massive series of healthcare fraud schemes. These schemes aimed at defrauding the federal government of an estimated $14.6 billion. This has resulted in charges against hundreds of individuals across the country. In what the department has called the largest healthcare fraud initiative in its history, the nationwide operation resulted…
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Bestmed’s Innovative AI Solution Against Fraud
Bestmed Medical Scheme, South Africa’s fourth-largest open medical scheme, is preparing to integrate Artificial Intelligence (AI) into its systems. This initiative aims to combat the growing scourge of fraudulent claims plaguing the healthcare industry. Protecting members’ funds and ensuring the scheme’s long-term sustainability amidst rising operational pressures are also goals. Bestmed CEO and Principal Officer Leo Dlamini confirmed that the…
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Final report on racial profiling investigation delayed again
The long-awaited final report from the Section 59 Investigation Panel, appointed by the Council for Medical Schemes (CMS) to probe allegations of racial profiling and discrimination by medical schemes and their administrators, has been delayed once again. The CMS now anticipates the report’s release by the end of the year, following ongoing challenges beyond its control. Initially launched in 2019…