GEMS Discovers Fraud Among Doctors and Specialists

    January 22, 2017

    It’s not only fraud and corruption claims at the SABC; now GEMS discovers fraud among doctors and specialists guilty of fraud too. So one might think that fraud and corruption have become a growth industry.

    It looks like in South Africa we just have to accept that there is any trust, reliability, integrity and justice.

    Health care fraud between medical aid members as well as healthcare providers is on the rise. And recently the Government Employees Medical Scheme (GEMS) has revealed rampant fraud as well as dodgy practices which are costing medical schemes millions of rands.

    GEMS Discovers Fraud Among Doctors

    The principal officer of GEMS, Dr Goolab‚ said the government medical scheme had uncovered instances where claims were dodgy.

    GEMS Discovers Fraud Among Doctors and Specialists Currently Rules

    It is mind boggling to realise that some 7 or 8% of all medical claims in South Africa are fraudulent. In 2016 healthcare fraud was one of the country’s leading crimes. And it just happened to be the most complex form of financial fraud to detect and prevent. Not only that, one would think that the fraud exists at admin level. However, it involves everyone, from the members of medical schemes to administrators to leading specialists.

    One just has to look at how easily people take sick leave and produce a doctor’s sick note. Just recently Discovery Health’s CEO, Dr Broomberg said that doctors even provide fraudulent sick notes to members.

    They then claim for a consultation. This apparently is just one of the scams uncovered by Discovery Health. Discovery Health’s Forensics department tackles roughly 3 000 forensic investigations each year and rising.

    GEMS Discovers Fraud Among Doctors and Specialists Caused by Leadership

    President Jacob Zuma, the government in general and the Gupta family, have set a self-enrichment example for South Africans. This kind of behaviour appears to be beneficial, and people from all walks of life are willing to try it out – after all it’s what our leaders are showing us by their example.Because of this mindset medical aids are losing billions of Rands each year through sheer wastage and fraud.

    KwaZulu-Natal has been identified as the province with the most fraud and abuse, so much so that a full-scale investigation has been launched. There are some health care practitioners linked to hospital cash back abuse.

    Acknowledgements of Debt (AOD) were signed by health care service providers including, among others, physicians, dietitians, physiotherapists and surgeons with AODs valued from R350 000 to R3 million. Dr Goolab went on to say that investigation wouldn’t cease and that the aim was to prosecute the people involved and to recover the amounts owed to GEMS.

    There are different ways that Hospital Cash Back Plan fraud occurs, but because no qualifying criteria exist to purchase a hospital cash back plan, it has become a target for greedy individuals looking to claim the cash.

    Self Enrichment on the Rampage

    Most medical schemes, their member as well as medical care professionals are honest and work hard, but there are those who follow the example of the South African government – to feather your own nest. They are the ones tarnishing the reputation of the health care system, but while Zuma and his cronies are setting such an example and going unchecked, there’s no knowing where these fresh fraud claims will take South Africa.

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    All info was correct at time of publishing