In recent years, medial aid members have experienced steady increases in their monthly contributions as the industry battles against the increasing cost of claims. A huge percentages of these costs can be attributed to fraud. That is one of the reasons why medical aid provider Polmed have recently launched a renewed crack down on fraud.
Fraud can deplete the funds that are available to payout on legitimate claims made by Polmed medical aid members, and that is something that Polmed are seeking to avoid so that members are not faced with higher contributions and fewer benefits. One of the steps that Polmed are taking is to try and educate their members on how they can personally help prevent fraudulent claims. In a recent newsletter sent to all Polmed medical aid members they offered the following tips for prevention and detection of fraud:
- Be sure to carefully compare the actual medical care you have used to the services which have been charged and report any discrepancies.
- Never allow service providers to use your medical aid card to claim any services that are not healthcare related.
- Be sure to be 100% truthful on all claims, falsifying any information is classed as fraud.
There are a number of different things which can be considered as fraud including pretending to be someone else in order to receive healthcare, lending someone your identity documentation including a medical aid card, using someone else’s medical aid card and making any kind of untruthful statement with the goal of getting medical care or pharmaceuticals.
Fraud is a very serious criminal offense and it is something that Polmed are taking very seriously. Any Polmed medical aid members who are discovered to have done anything which defrauds the scheme will face some very stiff penalties as well as a potential custodial sentence. Polmed have reiterated the fact that they operate a zero tolerance policy in regards to fraud and the company have now implemented a very solid task force which has the sole purpose of combating health care fraud. The task force can be contacted on 0800 200 564.
Prevention & Protection Tips
If you are a Polmed medical aid member, or a member of any medical aid scheme for that matter, you can follow these tips to both prevent and protect yourself against health care fraud.
- Never give out your membership number to anyone except your doctor or health care provider.
- Never give out your membership number over the telephone.
- Treat your medical aid card as you would your credit card – it is just as valuable.
- Use your personal health care journal or any other diary to record all of your health care including appointments, therapies and pharmaceuticals used.
- Review all claim statements for discrepancies, asking yourself these 4 basic questions each time :
- Did you receive all of the treatment listed?
- Did your doctor order any tests or products listed?
- Have you been billed for treatments multiple times?
- Is the service listed relevant to your condition?
With a little care and vigilance it is possible for you to help prevent health care fraud, which costs up to R13 billion every single year. With every rand which is claimed fraudulently the risk of legitimate claimants not getting the treatment they desperately need increases, so it is something that needs to be stamped out.
