Healthcare Forensic Management Unit (HFMU) South Africa

The objective of the Healthcare Forensic Management Unit (HFMU) South Africa is to curb the incidences of fraud and other inappropriate behaviour which contribute significantly to the cost spiral within the private healthcare funding industry. It is envisioned that through a collective approach, patterns of behaviour of those individuals acting fraudulently or inappropriately can be altered in conjunction with the relevant statutory, regulatory or professional bodies.

 The medical aid scheme industry is still faced with the continuously losing billions of rands to fraudulent activities, claims and submissions. Fraud and Corruption has created a need to have a platform whereby, all stakeholders within the healthcare industry can share information on how to combat fraud within the health sector.

 Raising red flags with regards private healthcare in South Africa

Curbing the spiraling effect of cost within the healthcare funding industry

-          Understanding medical aid scheme fraud

-          Fraud; abuse and misuse of funds; over-servicing; duplicate billing; kickbacks; over-billing

-          Fraud experienced by organisation and organisations vulnerability to fraud

-          How to detect fraud

 On-going problems in the healthcare system

-          Developing capacity and ethical values – how to diffusing ethical practices throughout the healthcare system

-          Maintaining efficiencies and effectiveness within the overall healthcare system 

Fraud preventative measures

-          Review process

-          Law Enforcement Agencies in South Africa

-          Investigations – fair and transparent

• Procedures and Rights
• Review of investigation transgressions within medical aid schemes

-          Continuous Professional development and Information sharing and its protocols