By Elma Ross
Cape Town - Medical Aid scheme fees are notoriously high, partly because of fraud scams by clients.
In 2018, a conference about these kinds of activities was held. It’s big.
There appears to be no algorithm (nor any precision checks by a dedicated individual) to check databases for new clients who get diagnosed at a government facility in one province, take out a hospital plan without declaring pre-existing conditions, and then move to another province to be “diagnosed for the first time” just days after their new hospital plan kicks in.
Also, tip-off facilities need people who have the ability to piece information together.
The average person who suspects something doesn’t have all the necessary information on a silver platter.
So loyal, long-term clients are being let down, as they end up subsidising the scammers.
Cape Times
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