Imagine finding out that your pharmacist or doctor has been arrested for submitting an account for care that was not administered, or for over-billing for supplies and services. Imagine finding out that he or she falsified patient data to obtain a higher payments from medical schemes, or had been paid kickbacks to refer patients to a specific specialist or clinic. These are some examples of medical scheme fraud, which exacts a human and financial toll on our nation. The loss of funds not only compromises the financial integrity of medical schemes, but also undermines their ability to provide healthcare services to the more than nine million people who depend on schemes. Medical fraud has directly affected the quality of health care and put some of the most vulnerable patients at risk. Many patients are harmed as a result of unnecessary procedure. Medical schemes and their administrators are having to spend substantial sums of money on analytical software capable of detecting irregular claims. Fraud and abuse are rife. It is estimated that at least 10% to 15% of all claims are fraudulent, abusive or wasteful in nature. In a R150-billion industry, that is a substantial expense. Fraud and waste are defined as intentional deception or misrepresentation, misreporting data to increase payments, paying kickbacks to providers for referring patients for services or to entities, or stealing providers’ or patients’ identities. Examples of fraud are billing for non-rendered services or supplies, misrepresenting diagnoses to obtain payments and accepting kickbacks. Abuse includes practices of providers, physicians or suppliers of services that are inconsistent with accepted medical practice, or that are not reasonable and necessary, resulting in unnecessary costs to medical schemes. One of the most common types of abuse involves the miscoding of claims. Every year, medical schemes are cheated out of billions of rands, which results in higher contributions and co-payments for members. Healthcare fraud and abuse are hard to contain because of a variety of factors, including the volume of claims associated with a single healthcare event and the emotive nature of “the story” linked to every claim. Payment by the medical scheme has become an expectation, a right that cannot be denied. Solutions for stopping medical fraud include: making better use of technology; higher penalties; improved provider enrolment procedures; greater rewards for reporting fraud; educating beneficiaries; and empowering patients and providers so they can identify and report fraud. Here are some important steps that members of medical schemes can take to ensure that they do not become victims of medical fraud.
Source: Personal Finance
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Disability cover protects you and your family if you are unable to do your job or you can no longer do normal day-to-day functions such as bathing, dressing or eating. With Old Mutual Greenlight Earning Ability cover you can choose between a lump sum or income benefit. Your income is the cornerstone of maintaining your standard of living. It is used to pay for everyday expenses such as food, clothing, electricity and bond repayments. Greenlight’s income benefits pay you a monthly income if you are temporarily or permanently disabled. The lump sum benefits pay out a once-off amount if you become permanently disabled. The funds can be used to cover immediate lifestyle adjustment costs such as making adjustments to your home and vehicle. Any excess funds can be reinvested to provide you and your family with an income. Disability income cover Disability Income Cover pays you a monthly income if you cannot work because of a temporary or permanent illness or injury. This can help replace any lost income, even if it is only for a couple of days or longer. Disability lump sum cover Disability Lump Sum Cover pays you a lump sum if you cannot work because of a permanent illness or injury. This can be used to pay for once-off disability related expenses and the remaining funds can be reinvested to provide you with a monthly income. Request for a quote for your disability cover, please contact Kevin or Thato in our Life Department, email life@daberistic.com, tel (011)658-1333 Source: Old Mutual We at Daberistic strive to guide and assist you with your Financial Planning with different plans for investing. We will be having a seminar in conjunction with FedGroup on Participation bond.
Participation bond is an investment option that allows you more room to move. You’ll be able to draw income from your investment, at a very competitive interest rate. To find out more join us on the day, details of event below. Date: 18 May 2017 Time: 12:30 - 13:30 (Refreshments served afterwards) Place: Block B, Infinity Business Park, 4 Pieter Wenning Road, Fourways (Next to Indaba Hotel) Please note that the presentation will be done in English and seats are limited.You are welcome to invite a friend. For more information, please contact Koketso, email office@daberistic.com, tel (011)658 - 1333 The higher your Vitality status, the greater your rewards!
Vitality members start at Blue Vitality status, progress to Bronze, Silver, Gold and, ultimately, Diamond status.Members who have earned enough Vitality points to get to Gold Vitality status for three consecutive years are awarded Diamond Vitality status in the following year. You can earn up to 30 000 points on a Vitality Wellness Day so to help you reach that goal Daberistic will be hosting, a one stop Vitality Wellness day. Event details below: Date : 16 May 2017 Place : Bock B, Infinity Business Park, 4 Pieter Wenning Road Duration: Approximately 1hr30min Time slots available : 8:00am to 15:00pm Please take note the cost for the assessment is R800.00 payable prior to the assessment which you can claim back from Discovery. The assessment includes: · Vitality Fitness assessment-Claimable from Medical Savings if on Discovery Medical Aid · Vitality Nutrition assessment - Claimable from Medical Savings if on Discovery Medical Aid · Health check assessment - Claimable if you on any Discovery Medical Aid option For payments please make deposit into below account : Bank: FNB Branch Code: Randburg 254005 Account holder: Daberistic Solutions Account Number: 62046638914 Cheque account Reference: Your Name & Surname Please send us proof of payment once payment is done For more information please contact Koketso office@daberistic.com or call us on 011 658 1333 |
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January 2025
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