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BusinessLive reports that according to consultancy Elsabé Klinck & Associates, medical scheme administrators are overstepping the mark in their fraud investigations into healthcare professionals.
It is alleged that they stray into the terrain of regulatory authorities and claim back money they have not proved they are entitled to. “In the name of curbing fraud, they have overstepped their mandates. They are making pronouncements on what equipment a practice should have, what a practitioner can and cannot do, and there are clawbacks that happen without losses being proven” said the firm’s Elsabé Klinck. This followed a presentation she made to the Council for Medical Schemes (CMS) inquiry into allegations that medical schemes unfairly targeted black, Indian and coloured healthcare professionals for forensic investigations. Klinck hopes the inquiry will make recommendations on how to resolve these issue, and other key aspects of how forensic investigations into allegedly fraudulent healthcare practitioners are conducted. Fraud is a major concern for the medical schemes industry, which says it is a significant driver of escalating monthly premiums. The CMS, which regulates the sector, said in February that fraud, abuse and waste cost the industry between R22bn and R28bn a year.
- Read the full original of the above report by Tamar Kahn at BusinessLive
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