BUSINESS OF MEDICAL SCHEMES

ANTI-FRAUD EFFORTS PAY OFF

LAST YEAR, Discovery Health’s efforts to curb fraud, waste and abuse in the health care system resulted in a substantial

R555 million recovered on behalf of the schemes it administers. “We also estimate that the ‘halo’ effect of our activities has prevented additional fraud, waste and abuse to the value of approximately

R5.1 billion in the past couple of years,” says the chief executive, Dr Jonathan Broomberg. Discovery employs a specialised team of more than 100 analysts and investigators and a forensic software system that uses algorithms to analyse claims data and identify unusual claim patterns. Of the 5 443 cases that were reported for possible irregularities, concerns were confirmed on about 75% of investigations.