MORE and more consumers are finding ways to bypass medical scheme rules, abusing medical aids and committing fraud, according to Paul Midlane of AfroCentric Health.
Midlane told You and Your Money’s Bryan Hirsch: “What we are noticing when there’s economic challenges and political challenges and when costs are on the rise and you have a health market inquiry, costs tend to go up. And there’s definitely an opportunity for opportunistic claiming and there are a lot of volumes of claims. People need to supplement their income.”
Midlane said some of the ways that people tried to dupe the system was by sharing their medical aid cards with relatives who had the same initials and surnames so they could claim benefits. Some consumers even went as far as buying baby formula from a pharmacy; the pharmacy would then submit a claim to the medical scheme only to find that no medicine had been dispensed. “People are using it as a grocery store,” he said.
Clayton Samsodien of Genesis EB Solutions said the regulatory framework did not help because medical aid membership was voluntary. Medical aid was a grudge purchase for most people and this is why they shopped for the cheapest option.
Samsodien and Midlane look at the possibility of reducing your premiums while keeping the same benefits.
In the last segment the experts look at brokers versus medical schemes. They unpack why people are reluctant to use brokers when the commission paid is the same as traditional medical schemes.
• You and Your Money airs on Business Day TV channel 412
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