Fight fraud to keep the cost of healthcare down

According to the Council for Medical Schemes, healthcare fraud is one of the fastest growing crimes in South Africa. This kind of fraud costs the South African economy about R930 million a year.

Fraud happens when someone intentionally lies or twists the truth for financial gain. An example of medical aid fraud is when a member of TFG Medical Aid Scheme lets a friend (who is not a member) use their membership card so the Scheme pays for medical treatment. People do this because they think they’re only taking money from the Scheme. In fact, if you steal from the Scheme, you steal from all the members.

Medical schemes don’t make a profit. Instead, they put all your monthly contributions together and pay administration costs and medical claims using everyone’s contributions. If someone who is not a member receives benefits, everyone else has to pay in more the next year to make up for the shortfall of funds.

We need you to Help us pay as many claims as possible by reporting fraud. You don’t have to give your name; you just have to tell us if you suspect fraud.  Details of our anonymous fraud hotline is listed below.

Cyber crime and your membership details

Your membership card shows personal information like your full name and ID number. This is sufficient information for criminals to steal your identity. Keep your card safe to protect your and your dependants’ information.

You should do more than keep your physical information safe. You should also protect your log-in details for the website. Don’t write down your password or provide it to anyone. If you think someone else knows your password, change your password at once.

A good way to choose a strong password you can remember is to choose four random words and use them as your password.

What can you do to fight fraud?

  • Check your claims and statements. Ask your healthcare provider for a copy of your claim and read the claim to make sure that it only lists services you’ve received.
  • Keep your membership card safe. Don’t give your card to anyone who is not a member.
  • Be careful if a healthcare provider says “they can make a plan”. Don’t accept any offers to make the amount you have to pay yourself less on any service or item.
  • If you’ve just joined the Scheme, tell us about any medical conditions you already have.
  • Tell us if someone approaches you with an idea to steal money from the Scheme or if you know of someone who is committing medical aid fraud. 

Use our anonymous fraud hotline to report fraud

We don’t have to know who you are to take your report seriously.

Fraud hotline: 0800 004 500

References

Council for Medical Schemes. CMS News Issue 1 of June 2018. Medical schemes fraud, waste and abuse. Accessed 27 January 2020

Money Marketing. Fighting fraud in the healthcare industry, 17 October 2017. Accessed 28 June 2018

Personal Finance. Medical scheme's fight against fraud and abuse is paying off, 25 March 2018. Accessed 28 June 2018

Times Live. Discovery uncovers more than R500m in fraud, 19 January 2018. Accessed 28 June 2018