Posts tagged with 'The Council for Medical Schemes'

 

Billions are lost due to Doctors, hospitals and medical aid members collude to commit fraud

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The Special Investigating Unit says it is actively targeting fraudsters in the private healthcare sector.

Fraud, waste and abuse is costing the private healthcare system more than R22-billion, and if you submit false claims, you could face more than just being terminated from your scheme, the Council for Medical Schemes warned at its summit on fraud this week.

The event comes after deputy president David Mabuza announced at the Presidential Health Summit that the Special Investigating Unit (SIU) would be honing in on the healthcare sector.

“We want independent investigations that are turned around quickly and submit and identify findings appropriately,” Mabuza said at the October gathering.

The CMS estimates that fraud, abuse or waste accounts for about 15% of the R160-billion in claims that medical aids pay out annually.

The head of the SIU, advocate Andy Mothibi, said the body is working with the National Prosecuting Authority to help ensure tha
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A change in birth options: What’s behind SA’s skyrocketing C-section rates?

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Almost one in four babies born at public hospitals come into the world via c-section but is it costing some women their lives?

For decades, Caesarean sections were a last resort for mothers and babies in distress. If you had access to this kind of procedure, you could count yourself among the world’s lucky.

At the dawn of the 21st century, rates of the procedure in almost all African regions save for the continent’s north dragged along at less than 5%, recently published research in The Lancetshows. Meanwhile, the continent was home to more than half of the 13 countries responsible for the majority of the world’s maternal deaths, World Health Organisation (WHO) data from the year 2000 shows.

At the same time, C-section rates in much of Asia and Eastern Europe hovered around 7%.

Almost 30-million babies will come into the world this year by Caesarean if 2015 figures are anything to go by — nearly double the number of infants delivered in this way alm
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New fears about medical aid law changes may cause ‘doctor drain’

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A key issue of the proposed Medical Schemes Amendment Bill is the impact on doctors, resulting from a proposed uniform tariff for healthcare services.

Concerns have been raised about the proposed Medical Schemes Amendment Bill, one of many health-related bills which have been going through various motions in Parliament.

Recently, the cabinet approved the Bill to regulate medical schemes, and it will now be published and made available for public comment.

Among the concerns raised is the impact of a proposed uniform tariff for healthcare services, leading to a possible exodus of doctors and other healthcare professionals to countries where they can get “full value” for their services by charging tariffs they see as reasonable.

Looking for a affordable Medical Aid or Hospital Plan, just click here Medical Aid or just send your Name, surname, age, area in which
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New Survey: Medical aid members have more choice

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In the battle for a slice of the private healthcare market, there has been significant growth in the number of medical schemes performing well across all sections of the medical aid spectrum. Whilst this means that members get more choice, it also makes the landscape increasingly complex.

The GTC 2018 Medical Aid Survey (MAS) analyses and rates medical aid schemes according to a standardised comparison and ranks the choices available to members.

When analysed purely in terms of premiums – the survey’s micro ranking – Fedhealth emerged as the medical aid which held the most top positions across all the classifications. Discovery was ranked in first place for the survey’s macro rankings, which analyses a medical aid’s overall ‘health’ and longevity in terms of factors such as its solvency level, membership growth, net healthcare result and member satisfaction. When combining both the GTC micro and macro rankings, Discovery claimed the highest number o
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Medical Schemes Act & NHI:- Motsoaledi outlines changes

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Two of the proposed amendments to the Medical Schemes Act will do away with co-payments, and abolish the practice of using brokers within the medical schemes environment.

Health Minister, Dr Aaron Motsoaledi, said co-payments mean that the scheme pays a portion of the bill that a provider – be it hospital or private doctor – charges to a patient. The rest of the funds are supposed to be paid by the patient from their own pocket.

“The amendment means that every cent charged to the patient must be settled fully by the scheme and the patient should not be burdened with having to pay. There are people who will scream that this amendment is outrageous and calculated to destroy medical schemes and leave beneficiaries with nothing. I want to assure you that this was well thought out,” he said.

According to data at the department’s disposal, medical schemes are holding close to R60bn in unused reserves. While there is a statutory requirement that me
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