In response to the HPCSA warning to practitioners against colluding with medical aid schemes and preferred provider networks administrators

One of the reasons The Board of Healthcare Funders’ Forensic Management Unit (BHF_FMU) was established, was to ensure that the investigation of fraud and abuse within the private healthcare sector, was conducted in an ethical, transparent and legal manner. The BHF_FMU will under no circumstances condone illegal or unethical conduct by any of its members, however, will strongly support and encourage its members to recover any monies lost due to fraud and abuse. It must be remembered that any monies lost by medical schemes due to fraud and abuse, in fact belong to the members contributing to those schemes and the trustees have an obligation to ensure that these monies are recovered as far as possible. Fraud and abuse contributes significantly to the high cost of private healthcare and in order to ensure the sustainability of the industry needs to be dealt with decisively. The industry is not only under pressure from consumers to control the cost of healthcare, but also from government.

The BHF_FMU currently estimates that as much as 10% (R6bn) of monies paid out annually by medical schemes are lost, due to fraud and abuse. We have on more than one occasion engaged with the HPCSA in order to ensure that we find the most appropriate way to deal with these issues. Currently the HPCSA’s ethical conduct investigation process, does not provide for the financial compensation to the scheme, which ultimately suffered the lost. We strongly feel that the rights of the consumers need to be protected in this regard.

We strongly support the HPCSA’s statement that the large majority of healthcare practitioners conduct themselves in an ethical manner and that they need to be protected against getting caught up in an unethical investigation. To this effect the BHF_FMU works very closely with various professional bodies and management groups representing healthcare professional in order to ensure that fair and transparent processes are followed. Furthermore, should complaints be received regarding unethical conduct by members of the BHF_FMU, remedial steps will be taken and if warranted, perpetrators will be expelled from participating in this initiative. Due consideration is given to each case investigated in order to ensure that it is dealt with not only in a legal, but responsible manner and where there is a positive obligation to report the matter, it will be done.

Released by The Board of Healthcare Funders of Southern Africa
Contact: Marius Smit – Chairman, BHF Forensic Management Unit
Tel: 011 529 2815
Cell: 082 606 2721