Fraud is a strange thing. How many of us have a very different attitude to fraud and corruption on a government or corporate level, but turn the proverbial blind eye to our own transgressions? Those little white lies which are supposedly ‘harmless’ may actually be the beginning of a slippery slope.
I was pondering these things when I saw an article in the Cape Times recently which commented on the Health Professions Council of SA’s investigation into medical aid fraud, said to amount to R22 billion a year.
There have been stories of doctors billing for 214 hours of consultations in a single day, and bills being loaded with codes for procedures which were never performed, or medicines which were never dispensed. In my time in the administration side of a health fund I was always unpleasantly surprised by the, admittedly few, doctors who used the coding systems to extract more money for themselves. The result has been the development of very sophisticated code tracking systems to identify these types of case gain activities.
As the article pointed out, fraud is not a victimless crime. In fact, the victims are always you and me, no matter how big the fraud appears to be.
We all have a role to play. Trying to game the system hurts us all, and in fact we are robbing ourselves. Taking care of our health is what is important.
The questions we should ask is: “What am I doing to keep costs down?” That relates to our behaviour, exercise and what we eat.
Members of medical schemes need to get involved in the process and ask questions and negotiate prices like they do for all other purchases.
At the end of the day it is your and my money.