While many companies resort to traditional methods to combat fraud, Discovery Health has embarked on a revolutionary e-commerce initiative to overcome a situation which currently costs the healthcare industry is poised to save Discovery Health`s members millions.
Trent Rossini, head of eDiscovery, said the website was developed to counteract the misappropriation of millions of rands each year within the healthcare industry. "Fraud is a real situation, and although we would like to think it doesn`t touch our business, we must be realistic and tackle it head on. We launched the fraud hotline last year as the first wave of our campaign. The hotline, together with the internal forensic experts, has borne exceptional results by saving Discovery Health approximately R23.5-million in just three months of operation. The second wave of our anti-fraud campaign includes the introduction of Internet technologies. We are confident that the website will assist us in uncovering any existing or potential fraud."
The Anti-Fraud Website combines leading-edge technology and innovation with Discovery Health`s fraud and technical skills.
"The website has been designed with a webmail-type of interface to allow any party to submit information regarding a suspected crime online, without revealing their identity, thus ensuring total anonymity. The website provides a unique means of submitting information as it allows one to register under an alias," says Rossini.
"Anonymity is vital to the informant as the main sources of leads received by investigators are from staff, service providers and members who may feel threatened by the prospect of being targeted by the perpetrator."
Of the 160 cases reported, either via the hotline or direct to the forensic unit, 70% have been investigated and closed.
"As a healthcare funder, fraud is not just our problem. It is also impacts on our members. Excessive fraud can lead to increased premiums and rates. With the launch of our campaign we have provided an incentive for people to report fraud or suspected fraud. For every case that is solved and closed, the informant is awarded 10% of the money saved. In addition, all names registered are entered into a monthly draw with a prize of R25 000 as a token of Discovery Health`s appreciation for taking an active role in combating crime."
"Money recovered as a direct result of members, providers and staff informing the forensic unit about irregularities to date amounts to about R700 000, while R80 000 has been paid out as rewards to callers," says Rossini.
"For those who take a sincere and vested interest in their `crime reporting`, the website allows the reporter of the crime to track the progress of each incident that undergoes investigation. This is highly rewarding for those who want to see the results of their reporting."
Discovery Health has entered into another initiative in an effort to combat fraud with Healthbridge, a joint venture between Discovery Health, Dimension Data and Medscheme. Healthbridge issues digital certificates to health care providers under stringent guidelines. Should any fraud be detected, the certificate can be revoked immediately, thus instantly disabling the submission of claims to any of the funders that form part of the Healthbridge network.
"Furthermore, when members arrive at a service provider, they can be instantly validated against the live systems of Discovery Health. This means the service provider knows instantly whether a patient has benefits available, or if they have left the fund. When the service provider has treated the patient, a real-time response tells the service provider how much Discovery Health will pay for the particular claim, and the balance can be immediately collected from the patient."
"We see a future in which fraud is incredibly difficult to commit because of the prolific use of technology. This will support the long term viability of medical schemes, low inflation and less bad debt which results in lower costs for our members," concludes Rossini.
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