Katharine Child
CORRUPT doctors, pharmacists, physiotherapists, radiologists and pathologists are ripping off medical aids to the tune of R22-billion a year – resulting in members having to fork out thousands of rands more in premiums.
The alarming increase in fraud has become a nightmare for almost 100 medical aid schemes and has prompted the Board of Healthcare Funders, which represents medical aids, to convene a two-day conference in Johannesburg to deal with the problem.
On the first day of the conference yesterday, medical aid investigators detailed some of the brazen tactics employed by medical professionals.
In one instance, the Polmed scheme caught out a physiotherapist who billed for 93 appointments in one day – she billed another scheme for more than 100 appointments on the same day.
A doctor billed a scheme for 107 appointments in a day, each taking two hours.
In some cases doctors treated patients in Durban, Bloemfontein and Pretoria on the same day.
The international head of information analysis company SAS, Chris McAuley, said the company had analysed almost 2½ years of medical aid data.
A subsequent report estimated that each member of a medical scheme in South Africa was effectively paying between R2500 and R2800 a year to cover fraudulent and irregular expenditure.
