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Mediclinic News : PRICEY MEDICAL AID – OR GOVT CARE?

Title

PRICEY MEDICAL AID – OR GOVT CARE?

Date

2019-03-03

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News Description

SATURDAY CITIZEN South Africans love to complain about many things but seldom about their own con duct, either individually or as a nation. So, many will moan about the shockingly high cost of medical aids – or the fact that medical aids will fight their members tooth and nail when it comes to payouts for procedures or medicines. It doesn't help, of course, that many of these private companies are making a fortune and sitting on huge piles of cash, or conducting their business from lavish office blocks. However, greed and uncaring medical aid corporations are not the only reason we are paying sky high premiums. According to the Council for Medical Schemes, fraud, corruption and abuse in the sector costs between R22 billion and R28 billion a year. Board of Healthcare Funders of SA managing director Katlego Mothudi estimated this criminal behaviour results in you paying up to 25% more than you ought to on your premiums. Fraud includes intentional deception or false representations, resulting in payouts which should not be made. At the same time, waste where medical services or medicines are obtained when they are not strictly necessary is also a significant cause of unjustified expenditure. At a medical aid summit this week, industry players were told of a number of examples of the rampant abuse and theft. One Eastern Cape lawyer was arrested for allegedly making six fraudulent claims, totalling R90 million. Last year, speech therapist and audiologist Wandile Theophilus Mashego was given a five-year, wholly suspended, jail sentence after being convicted on 259 counts of medical aid fraud. The scams and thievery may have a major unintended consequence: they are the ammunition the government is using to justify the introduction of a National Health Insurance Scheme ... something which might make us long for the "good old days of ordinary medical aids".
Created at 2019/03/11 09:06 AM by Mediclinic
Last modified at 2019/03/11 09:06 AM by Mediclinic