KPMGs medical schemes anti-fraud survey results
Publish date: 20 July 2006
Issue Number: 22
Diary: Legalbrief Forensic
Category: Corruption
In the results of its medical schemes anti-fraud survey released this week, KPMG Forensic found that of the R28bn claims paid for the year, the value of investigated claims amounted to R213m less than 1%.
But, it says, given that experts in the Medical Schemes industry estimate fraud of 10% to 30%, the investigators appear to be just scratching the surface. The survey found that over the year period covered in the survey, 28 279 cases were investigated but only 238 were reported to the police, resulting in 17 convictions, and 380 cases were reported to the relevant governing bodies, with only 10 strike-offs. And the principal enabling factor for fraud was found to be collusion between members, service providers and administrator staff. Full KPMG survey report
