SA's biggest medical scheme for public servants says the country is losing R22 billion a year to fraud, waste and abuse in the healthcare industry. Globally, it is estimated that about R4 trillion is lost through healthcare fraud.
In the past year, schemes uncovered by the Government Employees' Medical Scheme (GEMS) to defraud it include pharmacies colluding with members and other healthcare providers to create "cash-backs". Some specialists are billing for services not rendered.
"We are losing lots of money due to these types of offences," said GEMS senior manager for operations and risk Ishmael Mogapi during a symposium that the scheme held on Friday.