MEDICAL aid fraud is on the increase and sometimes occurs without the knowledge of the medical aid member. It is important for medical aid members and practitioners to be aware of what is happeni
ng so that they can be on the look-out for it
The following is a true story but the names used are fictitious. An estranged wife by the name of Ellen Jomo availed her son’s medical aid card for use by her brother’s son Taka without the knowledge of Jomo, the contributing medical aid member.
Ellen’s son, Jomo Jr and Taka were of the same age. Taka went regularly for operations and other treatment by his doctor. A month would hardly pass without Taka being seen or operated on.
On all the occasions Taka was treated, he went under the name of Jomo Jr as this was the name on the medical aid card. Taka died in March and the cat came out of the bag.
The doctor discovered discrepancies with regard to the names because the real name of the deceased was revealed as Taka Dzafa. It is not known how the doctor eventually resolved the matter, but it was an embarrassing event to the practitioner, and a costly reckoning for Ellen Jomo and her brother.
Medical aid fraud increases your subscriptions to medical aid. An increase in medical aid subscriptions in turn reduces your take-home income. If you come across any suspicious moves related to medical aid, do not hesitate to report to your medical aid society or to Namas.
Executive secretary, Namas,