Cost of medical aid fraud

DO you sometimes wonder why medical aid contributions are so high now? To find out some of the reasons, read on. This is a true life story.


Maidei and Sifiso (not

their real names) were sisters. Sifiso was involved in a road traffic accident and left unconscious. She was rushed to hospital and admitted into the Intensive Care Unit where she stayed for two weeks. In that period her treatment costs rose to $2,2 million.


Sifiso did not have medical aid cover. So Maidei, in sisterly love and desperation, used her own medical aid card so that Sifiso’s hospital bills could be settled by the medical aid society.


Unfortunately Sifiso died. As the hospital authorities were jotting down details of the deceased, they noticed that Sifiso’s ID number and name differed from that on Maidei’s medical aid card. The hospital then demanded full payment in cash from Maidei.


The case was reported to the police as fraud.


The medical aid society, having been informed of the incident, cancelled Maidei’s medical aid membership. All other medical aid societies were informed and Maidei was blacklisted and cannot join any other medical aid society.


I am aware that if any member cheats the medical aid system in this way and is not caught, everyone on medical aid eventually pays for it.


This is how: the overall healthcare costs incurred by a medical aid society (through genuine payments or fraud) determine the amount each member pays in subscriptions to that society.


Job Chiviru,

Graniteside.

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