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Effects of Fraud

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How fraud affects our daily life
Healthcare fraud costs the South African healthcare system billions of rands each year. Medical schemes are among the biggest victims. This makes healthcare fraud one of the largest taxpayer rip-offs.

Organised crime rings hatch many schemes. Hospital chains, individual employees, doctors and even patients can be involved – as victims or perpetrators.

The impact of this on you is summarised below.

Exhaustion of benefits

Your benefit limits might be drained by worthless or unnecessary treatment that never occurred.

False medical records

Your medical records may contain false information about illnesses, diseases, injuries or other problems you never had, but claimed for. Your information is available to the Scheme, so you could have been categorised as a high-risk member, e.g. you might have claimed for diseases that your life insurer will in future decline to cover because it was not disclosed on your application form.

Increases in contribution rates

Your monthly contributions may be increased because the Scheme passes the cost of fraud onto members.

Criminal record

Upon successful completion of a criminal case, the member or service provider might end up with a criminal record, which may affect his or her reputation and can lead to the loss of jobs or income.