Healthcare fraud to come under the microscope

12 Apr, 2019 - 12:04 0 Views
Healthcare fraud to come under the microscope

eBusiness Weekly

HARARE – Health insurers, under the banner of the Association of Healthcare Funders of Zimbabwe (AHFoZ) will in June this year convene to discuss ways of eliminating health insurance fraud which has emerged as one of the biggest contributors to financial losses incurred by players in the sector.
Health care fraud is a type of white-collar crime that involves the filing of dishonest health care claims in order to make a profit.
It comes in many forms including when individuals obtain subsidized prescription pills that are actually not needed to sell on the black market for a profit or when practitioners bill for care that they never rendered or filing duplicate claims for the same service rendered.
In Zimbabwe, cases of healthcare fraud have risen sharply from 32 recorded in 2014 to 157 in 2016, resulting in most health insurers incurring huge financial losses.
In light of this, the health insurers will gather in June for a two day convention to devise ways to stop the crime.
“The main objective (of the conference) is to raise awareness, demystify and identify ways to eliminate healthcare fraud, waste and abuse,” said AHFoZ in a statement.
According to AHFoZ, following investigations of healthcare fraud cases, a total of $1.9 million was recovered in 2016 up from $159 278 the previous year.
Globally, losses due to healthcare fraud have risen steadily, costing the United States for example, as much as $68 billion annually, according to statistics from that country’s National Heath Care Anti-Fraud Association.
This week, American authorities reported that they had dismantled one of the largest health care fraud schemes ever investigated by the FBI, charging 24 people in an alleged $1.2 billion scam.
Reports suggest that as part of the scam, doctors got kickbacks for prescribing unneeded drugs for back, shoulder, wrist and knee braces to elderly and disabled patients and charging the government Medicare program. – New Ziana


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