Medical aid fraud costing members an arm and a leg


Tips to help your medical scheme root out fraud

  • Check your medical scheme statements to make sure you received the services that were claimed for. Medical professionals often submit claims directly to the Scheme which means you might not know about them.  Providers have been known to claim for related services to your condition without having provided them to you.
  • Make sure the medication your pharmacy gives you is what they are claiming for.  It is often the case that pharmacies give you the generic but in some cases, may claim for the more expensive branded medication.  If they give you a generic, be sure to check that is what they claimed for when you sign for the medication.
  • Make sure your details are correct on the account from your provider and that the bill is for the right member of your family. In some cases providers claim for multiple beneficiaries when service was only provided to one.
  • Don’t lend your medical scheme card to anyone. Receiving treatment by pretending to be someone else is fraud!
  • Report any suspicious activity.  If you think a provider is participating in fraud, let us know immediately.