04 Fraud, Waste, and Abuse in Healthcare

In this episode, we discuss fraud, waste, and abuse in healthcare, specifically within the GEMS medical aid scheme. Host Uveka Rangopa speaks with guests Ishmael Mogapi (GEMS Senior Manager, Operations Risk), Nomfundo Dhlomo (Head of JIMS Claims Risk Management), and Dr. Gregory Pratt (Head of Claims Risk).

The discussion begins by defining fraud, waste, and abuse in healthcare. The panel then speaks about the significant financial impact on medical schemes and shares concerning trends. They discuss the consequences and emphasise the importance of members protecting their medical aid details and reviewing claim statements, encouraging whistleblowing, and highlighting GEMS' improving analytical capabilities to detect fraud. GEMS on Facebook · Connect with GEMS · Follow GEMS on X · GEMS on Instagram