Findings from multiple organisations found that fraud, waste and exploitation contribute to a high percentage of erroneous medical claims in the region. Indeed, the Board of Health Care Funders of South Africa found that 40 per cent of medical aid schemes’ claims in the region are forged; while reports from Medical Aid Society of Malawi (Masm) and Horizon Health Malawi – both major health insurance providers in the country – also confirmed this, with 25 per cent and 40 per cent of their claims, respectively, being fraudulent, costing them around MWK6 billion (US$8.2 million) a year.
In response to this worrying figure, health insurance funding bodies have come together to tackle medical insurance fraud. Liberty General, Horizon Health Malawi, MedHealth and Masm have now formed the Health Funders Association of Malawi (Hfam). Watch this space.
Hfam Interim President Elsie Munthali, who is also CEO for Horizon Health Malawi, said the most common fraud involves schemes’ members conniving with service providers to pay them cash, which in turn the service providers claim as if they provided the service.
“That is the most serious fraud we are currently facing as an industry. On our part as Horizon, we calculate that between 40 and 50 per cent of our claims are fraudulent in nature because fraudsters have now become more sophisticated. So, that’s why we have come up with this association to start talking and acting with one voice,” she said.