Healthcare Fraud, Abuse And Waste

Preventing Healthcare Fraud, Abuse, and Waste: A Shared Responsibility

“DO NOT sign your name on a blank form. Ask for a copy of everything you sign. Keep the copy for your records.”
Understanding the Continuum: Waste – Abuse – Fraud
Healthcare fraud, abuse, and waste exist on a continuum of intent and behavior. Each has varying degrees of impact and consequences, but all contribute to rising healthcare costs and weakened trust in the system.
Waste refers to inefficient or unnecessary services. A common example includes the unbundling of procedures—charging separately for services that should be billed together at a reduced rate.
Abuse includes excessive or unreasonable billing practices, such as upcoding (billing for more expensive services than were provided), or charging for services that are not medically necessary.
Fraud is a deliberate attempt to deceive. This includes falsifying claims, billing for services never rendered, or using someone else’s medical aid card. Fraud is the most severe form of misconduct on this continuum.
What Can You Do to Prevent Healthcare Fraud, Abuse, and Waste?
As a consumer, your active participation is essential in helping to reduce fraud and abuse. Here are simple, practical steps you can take:
Why It Matters
Fraud, waste, and abuse in healthcare cost everyone—you, your medical aid fund, and the system at large. Once a fraudulent claim is paid, it’s often too late to recover the loss, and victims may struggle to correct their records. Every rand lost to fraud is a rand not available for legitimate care. Your attention and action can help stop a fraudulent act before payment is made, which is the most effective form of prevention.
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