Total cost of fraud in SA private healthcare system about R22-bn a year.

At a recent webinar on corruption in the private sector, Katlego Mothudi, the Board of Healthcare Funders’ managing director, said the sector should be sharing data and strategies to allow fraudsters little room to move. Mothudi said there should be partnerships with law enforcement entities because the industry cannot be the judge and the jury [when it deals with fraud and corruption], reported Daily Maverick (29 November 2020).

According to the Council for Medical Schemes (CMS) the total cost of fraud in the SA private healthcare system amounts to about R22-bn a year. Mothudi said the majority of cases involved false claims, where healthcare professionals claim for services not rendered or claim for incorrect services. Fraud, abuse or waste accounts for about 15% of the R160-bn in claims that medical aids pay out annually.

A Corruption Watch report on corruption in SA’s public hospitals found that the most common form of corruption was employment corruption (39%), followed by procurement corruption (22%), and the misappropriation of resources (16%).

Mark Heywood, Maverick Citizen’s editor, who facilitated the webinar, said: “We talk a lot as though corruption is limited to the public sector, but the private healthcare sector is just as vulnerable to fraud and corruption”.

 

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