Discovery defends clawing back money after ‘irregular billing’

 

On June 17, Fin24 reported that Discovery Health said it had been clawing back money from doctors following “irregular billing” to protect its medical aid members. The medical schemes administrator has come under fire for allegedly claiming back money it had paid to healthcare providers years ago - when medical schemes are supposed to address any disputed claims within 30 to 60 days of receiving them. Discovery Health said medical schemes have the right under the Medical Schemes Act to recover or claw back money already been paid to medical providers where they have “positively identified that irregular billing has occurred”.

The industry would lose at least R1.7-bn of member’s medical aid money to fraudulent claims per year if it did not curb billing abuse, a spokesperson for the medical scheme said.

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