6 Medical Aid Claim Fraud Hotspots

1. Doctors submit claims for services that have not been rendered to patients.
2. Dispensing doctors and pharmacies provide members with low cost generic medicines and claim for higher cost brand name medicines.
3. Doctors provide fraudulent sick notes to members and then claim for a consultation from the scheme.
4. Pharmacies sell cosmetics and other “front shop” items to scheme members, and submit fraudulent claims for medicines to the scheme.
5. Members, in collusion with doctors and hospitals, submit claims for false hospital admissions, in order to benefit from the claims payment.
6. Members forge and submit claims for services supposedly rendered by healthcare professionals, but which were never actually rendered.

Source: Health24
Source URL: http://www.health24.com/Medical-schemes/News/revealed-discov...

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