Private ambulance fraud tackled

THE private ambulance industry is contributing significantly to KZN’s reputation as having the highest rate of medical aid fraud in the country.

This is the view of Oliver Wright, CEO of the South African Private Ambulance & Emergency Services Association (SAPAESA).

He was responding to the

Zululand Observer’s query on the number of ambulances that are apparently operating as taxis and are seldom, if ever, seen at accident or other trauma scenes.

‘While there are some excellent private ambulance services, a number are perpetrating fraud by literally ferrying patients from doctors’ rooms to hospitals, often in instances where the use of an ambulance is not indicated.

‘This abuse only serves to drive up medical aid premiums on an annual basis.

‘Ironically, it is the patients who end up suffering by bearing the brunt of excessive medical scheme premium increases,’ said Wright.

‘A number of these unethical ambulance services have been caught out for submitting fraudulent medical scheme claims and we are pleased to see that many of these are no longer operating and have closed down after medical schemes suspended payments to them owing to the proliferation of fraudulent claims.

‘We commend the respective medical schemes for their actions.

‘Taxis’ swindle medical aids and Road Accident Fund

‘It is unfortunate that in a number of instances, government entities such as the Road Accident Fund are also being defrauded by these same, unethical ambulance services but that these same entities do not seem to have the resources required to take action to stop these fraudulent claims from being paid to unsavoury providers,’ said Wright.

‘SAPAESA would like to take this opportunity to urge the Road Accident Fund to put dedicated staff members in place to investigate fraudulent ambulance service claims and to take the necessary action to prosecute them to the full extent of the law

‘We currently see that where ambulance services are suspended as providers for medical aid schemes, they often continue to defraud the Road Accident Fund.

‘These same ambulance services then go on to grow in size and operation and thus defraud the

Road Accident Fund in even greater numbers.

‘Ironically, by not putting a stop to it, the Road Accident Fund is facilitating the growth and ongoing fraud of these same service providers.’

No re-inspections

Wright said another problem in terms of regulation is a lack of action by the Board of Healthcare Funders of South Africa (BHF) to manage ambulance service practice numbers previously issued by BHF.

‘Typically BHF will only inspect an ambulance service once - upon application for a practice number.

‘After this initial inspection, the BHF does not take any action to facilitate regular re-inspections to ensure compliance with the various accreditation requirements.

‘This then results in a decline in accreditation standards with a number of service providers who see no necessity to remain compliant.

‘Once again, it is the patient who ultimately ends up suffering when they are treated by a non-compliant, sub-par service provider.

‘SAPAESA has gone as far as to offer to conduct annual reinspections of all ambulance service providers at no financial cost to the Board of Healthcare Funders.

‘Sadly, this offer appears to have fallen on deaf ears.’

Wright encouraged members of the public to only make use of ambulance services that are SAPAESA members, as they adhere to a code of conduct as well as to the BHF accreditation criteria.