Help us to protect your cover
To protect your benefits and ensure that your cover is always in the right hands, Liberty Health has a dedicated forensic team responsible for managing fraud risk in countries where we operate, or where we operate alongside our partners.
These countries include: Ghana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Nigeria, Tanzania, Uganda and Zambia.
Although the majority of healthcare providers are honest and ethical, fraud and irregular practices do occur. Not only does this occur amongst doctors and pharmacists or at hospitals and clinics, but also amongst some policyholders.
What is unethical behaviour?
Unethical behaviour is an action that falls outside of what is considered morally right. Sometimes this could mean deceiving others for one’s own benefit or financial gain. The following are indicators of unethical behaviour which constitute healthcare fraud:
- Using someone else’s policyholder card or letting someone else use your card.
- A provider supplying non-medical services (selling nappies) and claiming for these costs
- Submitting false information on your claim form
- A provider claiming for services not rendered
What needs to be reported?
Please be on the lookout for the following, which you can report anonymously:
- Abuse by policyholders and healthcare providers
- Unethical and/or dishonest behaviour by healthcare employees
- Any unlawful, irregular or unethical conduct
- Claims fraud
- Over-servicing by providers
- Charging more than once for the same service
- Claiming for services already paid
- Collusion between members and providers (agreeing with your doctor or service provider to send in a false claim and then sharing the money once the claim is paid)
- Theft, fraud, bribery and corruption
Be vigilant about fraud
Did you know?
- You should check your claims statement to ensure that you are not billed for a service that you did not receive.
- The more fraudulent claims that are paid, the more you pay for medical cover
- You can help us prevent fraud by reporting it.
As a policyholder, you can help us curb fraud by always checking and keeping track of your health insurance claim statements to make sure all healthcare claims on your policy are valid. Make sure you always ask for a copy of the claim and check that only the services or items you received are on it.
Also, never give or lend your card to anyone who is not a registered dependant on your policy. Only your registered dependants, are entitled to benefits on your policy.
How to report allegations/suspicions for investigation
To report matters directly to us, you can contact us on firstname.lastname@example.org, or use the following anonymous fraud hotline for South Africa: 0800 63 67 25.