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‘Healthcare fraud must be investigated’

Discovery Health CEO Jonathan Broomberg urged medical aids to probe fraudulent claims.

FILE: Discovery Health’s CEO spoke about various issues affecting insurance providers at the Healthcare 2020 Summit. Picture: Discovery Holdings

CAPE TOWN - Discovery Health Chief Executive Officer (CEO) Jonathan Broomberg on Thursday urged healthcare schemes to investigate claims that appear to be fraudulent.

He made the comments at the Healthcare 2020 Summit in Sandton, north of Johannesburg.

Broomberg spoke about various issues affecting insurance providers.

He estimates about R3 billion is lost annually to false claims.

"People are not getting away with it anymore. We are identifying fraud very frequently and we are recovering back claims from fraudulent activity."

Broomberg on Wednesday addressed the issue of healthcare inflation.

He said on average, premiums have increased by just over 11 percent annually.

The CEO also said that over-treatment, pricing failure and abuse were some of the factors affecting cost tariff increases.

He added that while some hospitals and a few doctors may be guilty, syndicates are at work attempting to extract money from those who have cashback health policies.

Broomberg said the highest amount of fraud is taking place in KwaZulu-Natal.

The summit comes at a time when government is seeking greater intervention when it comes to pricing.

The Competition Commission of South Africa is also investigating the matter.

The inquiry, which started its work in January, was tasked with probing factors driving healthcare costs and expenditure.

The commission looked at the private healthcare market as a whole.

The private hospital industry is dominated by three companies - Netcare, Life and Mediclinic.