Council of Medical Schemes is looking at R122 Billion of fraud, waste and abuse

According to the Council of Medical Schemes, up to 15% of all medical aid clams are associated with fraud. Going back to 2017 figures, the expenditure was about R122 billion. This means that the council is looking at R122 Billion of fraud, waste and abuse.

In terms of the service providers, we have been made aware of medical aid schemes submitting false claims and over billing and falsification of patient information.

Dr Sipho Kabane, Acting chief executive and registrar - Council of Medical Schemes

Acting chief executive and registrar of the Council of Medical Schemes, Dr Sipho Kabane, said as the council's aim is to regulate the entities that are under its umbrella. These include: medical aid schemes, administrators, and brokers.

He says the Health Professions Council of South Africa, whose role is to regulate service providers, has been operating in a different manner, and that is why fraud, waste and abuse has thrived over the years.

We are sitting with a pile of complaints from members and service providers on issues around fraud and we wish to resolve these issues as soon as possible.

Dr Sipho Kabane, Acting chief executive and registrar - Council of Medical Schemes

Kabane said that, in some cases, clients also help the service providers to commit fraud.

Click below to listen to the full interview:


Recommended

by NEWSROOM AI
Read More
[LISTEN] W Province Tourism allays fears after Mount Nelson Hotel robbery

[LISTEN] W Province Tourism allays fears after Mount Nelson Hotel robbery

W Cape Economic Development and Tourism Deputy DG, Rashid Toefy, talks about the impact this may have on the industry.

Zondo Commission: 'Zuma under increasing pressure'

Zondo Commission: 'Zuma under increasing pressure'

News24 assistant news editor Pieter du Toit says the former president lost the initiative on Day 2 of his testimony.

'May we repeat Asimbonanga, with the words, we remember you, we saw you, Johnny'

'May we repeat Asimbonanga, with the words, we remember you, we saw you, Johnny'

Nelson Mandela Foundation's Sello Hatang, Sipho 'Hotstix' Mabuse, Martin Locke pay tribute to SA music icon Johnny Clegg who died.

Free app helps calculate child maintenance

Free app helps calculate child maintenance

Mediation Acandamy co-founder Barry Greyvenstein explains how the app works.

Medical aids will struggle to survive NHI, shows leaked document

Medical aids will struggle to survive NHI, shows leaked document

The Money Show’s Bruce Whitfield interviews Dr Nicholas Burger.

Community leader vocal on vacant land after 4000 displaced in Masiphumelele fire

Community leader vocal on vacant land after 4000 displaced in Masiphumelele fire

Two people have died and at least 4 000 others have been left displaced after a blaze in Masiphumelele destroyed over 800 shacks.

Popular articles
Beware 'dodgy' Nadal vs Federer ticket offers

Beware 'dodgy' Nadal vs Federer ticket offers

The Roger Federer Foundation says no ticket platforms are yet in possession of, nor have guaranteed allocation of tickets.

[WATCH] Mzansi's Ndlovu Youth Choir headed for AGT's live shows!

[WATCH] Mzansi's Ndlovu Youth Choir headed for AGT's live shows!

The choir that is stealing America's hearts is headed to the next round of America's Got Talent.

[LISTEN] Voice of the underworld - a 'retired' Cape Flats gangster speaks out

[LISTEN] Voice of the underworld - a 'retired' Cape Flats gangster speaks out

Jason is a 50-year-old former member of The Americans, the largest street gang operating in Cape Town.

Shark attack: 'I saw a cloud of blood in the water'

Shark attack: 'I saw a cloud of blood in the water'

Joao Felizardo helped rescue his surfer buddy Dusty Phelan after a shark bit him across both his legs in Port Alfred.

'Batchelor was once close to Mikey Schultz and self-confessed Kebble killers'

'Batchelor was once close to Mikey Schultz and self-confessed Kebble killers'

Journalist and author Mandy Wiener describes former footballer Marc Batchelor's links to alleged underworld figures.

How Christo Wiese became the richest in SA, and how it all came crashing down

How Christo Wiese became the richest in SA, and how it all came crashing down

The Money Show’s Bruce Whitfield interviews TJ Strydom, author of “Christo Wiese - Risk And Riches”.

'I should have told the Sunday Times the pot smoking was irrelevant'

'I should have told the Sunday Times the pot smoking was irrelevant'

Investigative journalist Jacques Pauw says he's sorry for any harm caused in his article on Mkhwebane and her principal witness.

South Africans held in Syria went there to join Isis - Trac

South Africans held in Syria went there to join Isis - Trac

Intelligence and terrorism expert Jasmine Opperman says there are seven women and about 15 children held in Syrian camps.

[WATCH] Over 50 artists record special version of Johnny Clegg’s  “The Crossing”

[WATCH] Over 50 artists record special version of Johnny Clegg’s “The Crossing”

For this week's #GoodNewsThursdays, we find out the inspiration behind the production.