Medical scheme administrators overstepping the mark in fraud investigations
While fraud is a major concern for medical schemes, they are straying into the terrain of regulatory authorities, say some
Medical scheme administrators are overstepping the mark in their fraud investigations into healthcare professionals, straying into the terrain of regulatory authorities and claiming back money they have not proved they are entitled to, according to consultancy firm Elsabé Klinck & Associates.
“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 founder Elsabé Klinck, shortly after making a presentation to the Council for Medical Schemes (CMS) inquiry into allegations that medical schemes unfairly target black, Indian and coloured healthcare professionals for forensic investigations...
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