“SAMWUMED supports interventions to curb fraud, waste and abuse, but not at the expense of Black and Indian health-care practitioners.”
The South African Municipal Workers Union Medical Aid (SAMWUMED), is looking forward to the industry discussions and education of members about Fraud, Waste and Abuse, particularly during the Awareness Week.
This comes after investigation into the alleged racial profiling of Black and Indian health-care practitioners that was publicised a few months ago, which the Scheme eagerly awaits the outcomes thereof. Although we understand that as medical schemes we have a responsibility to protect the funds of our members, and Schemes cannot be required to continue honouring claims when the validity of those claims are in question, SAMWUMED is against any practice that prejudices health-care professionals, based on their skin colour. As a Scheme we will take the necessary steps against any service providers, including our own business partners who may be found guilty of such practices, as we believe in a non-racial and progressive South Africa, that exists to enable health-care professionals to provide quality healthcare services to our members, regardless of the colour of their skin.
SAMWUMED is concerned about the negative impact of Fraud, Waste and Abuse on Schemes and our members, as it is a contributing factor to high claims costs, which negatively impact the pockets of our members. The South African health industry is a R150bn industry and recent reports state that the total fraud costs in the South African private healthcare system, is estimated at about R22bn a year. It is in this context that the Scheme acquired the services of a Fraud, Waste and Abuse service provider whose primary mandate is to invigilate the claims that the Scheme receives and where there are any abnormalities, investigations must be conducted. This is a common intervention aimed at curbing high costs for our members that many Schemes have adopted, in the fight against Fraud, Waste and Abuse.
Notwithstanding the above South Africa is still faced with the inequalities of access to quality private care for our people, where we know statistics depict that only 16% of South Africans have access to private healthcare via medical schemes. “This is what we continue to fight to improve as one of our founding principles is that ALL South Africans, deserve the right to access quality health-care. We are still left challenged with many issues which include the cost of private health services which as a Scheme, through the interventions such as Managed Care programmes, we are working to ensure costs are kept at minimum. The de-regulation of costs and the need for negotiated deals between funders and health-care service providers, to avoid exorbitantly high medical aid premiums, remain a key strategic focus for SAMWUMED” said Principal Officer of SAMWUMED, Ms Francina Mosoeu.
‘’The ideal healthcare model that works would be whereby members are given the choice to choose medical aid cover from any service provider, are protected from fraudulent activities and members also take the responsibility to avoid colluding with health-care providers, in order to protect the risk pool for all members, and ultimately leading to lower medical aid premiums for our members. However if the very professionals we rely on for these services are being discriminated without solid evidence and only based on their skin colour, we will find a health-care system that continues to exclude and only benefits a fraction of South Africans.
SAMWUMED is fully behind the industry finding solutions to the issue of Fraud, Waste and Abuse and we believe only through regular engagement platforms are we on a good path to resolving the issues we are faced with ‘’ concluded Mosoeu.
The opinions expressed are shared by SAMWUMED and its Board of Trustees.