Medical claims shocker

THERE is need to evaluate how much money is lost due to medical fraud and waste in Zimbabwe amid revelations that medical claims from the private sector increased to over $400 million in 2015 alone.

Speaking at a workshop on medical fraud in Zimbabwe recently, Association of Healthcare Funders of Zimbabwe (AHFoZ) chief executive officer Mrs Shylet Sanyanga said trends showed that medical claims continue to increase over the years, raising eyebrows on whether this meant more and more people were seeking health services.

Mrs Sanyanga said in 2011, medical claims amounted to nearly $200 million.

“The challenge that we have is that we do not have statistics on what percentage of these figures are lost due to fraud or waste. We also do not know whether this means our people are getting sicker or our medical costs are getting higher by each year,” said Mrs Sanyanga.

She said statistics were vital as they provided useful insights on trends for appropriate decision-making.

“There is therefore need to compile, measure and analyse statistics on fraud, abuse, misuse and waste,” she said.

Internationally, it is estimated that 30 percent of claims are fraudulent, abuse or misuse of medical aid cards.

Speaking at the same occasion, First Mutual Health medical advisor Dr Tinashe Magumise said medical fraud in Zimbabwe was perpetrated mainly by service providers but also members and employers.

Dr Magumise attributed medical fraud to economic hardships currently prevailing in the country, increased disease burden, greed, loss of ethics and professionalism among others.

He said medical fraud, abuse, misuse and waste occurs through repeated claims, charging for services not rendered, over treatment, unnecessary investigations, charging using higher prices and people using other people’s cards among others.

Zimbabwe Medical Association secretary-general Dr Shingi Bopoto concurred adding all involved players were to blame.