If someone had your medical aid details, could they benefit in your name?


With credit fraud on the rise, most of us know the importance of keeping our general personal details safe, such as ID number, home address, and contact details.

But were you aware of the need to keep your medical aid or insurance details safe? We find out what the risks are of this information being compromised and what you can do to prevent this.

Tip: Get a quote for a medical aid plan today to find out whether you could save.

What is medical identity theft?

According to Reagan Mitchell, managing director at WealthyMe, medical identity theft involves the use of your medical aid information to gain access to healthcare services by someone else who has no right to claim.

He explains that this type of theft usually involves out-of-hospital claims, such as going to a general practitioner or filling prescriptions at a pharmacy.

“Medical identity theft could also take the form of a syndicate of medical professionals working with individuals who steal this information and share it with those who will then submit fraudulent claims,” says Mitchell.

“In many instances, members of medical aids take part in ‘card farming’, where they willingly share their details with family or friends, to enable them to gain access to healthcare services,” he explains.

What if fraudsters have your ID and medical aid details?

According to Lee Callakoppen, principal officer of Bonitas Medical Fund, there are steps in place to prevent someone else from using your medical aid.  

“In normal circumstances, the healthcare practitioner or hospital will ask for your medical aid card and ID document, rather than simply accepting the details you give them,” says Callakoppen.

However, Mitchell says that if someone has your medical aid card details and a fake ID with your name, they could make use of your medical services out of the hospital.

“If a fraudster has both your medical aid card and a fake ID, they would be able to access medical services in your name,” says Michell.

What’s the cost of fraud?

Callakoppen says that using someone’s medical aid details is fraudulent. It falls under the umbrella of Fraud, Waste, and Abuse (FWA) which costs the healthcare industry around R22 billion a year and is one of the main drivers of healthcare inflation. The Council for Medical Schemes (CMS) estimates that 15% of claims in the healthcare industry contain some element of FWA.

“Medical schemes are not for profit and are in fact owned by their members. So when a scheme is defrauded, it impacts funds to pay for claims and can contribute towards increased premiums,” says Callakoppen.

“We constantly urge our members to be vigilant and check their accounts and medical scheme statements to make sure that all claims are correct and that they actually received the services they were charged for,” he explains.

How to stay safe

Mitchell says that medical aid members need to keep their medical aid information in a safe and secure place at all times.

“If you lose your medical aid card, you need to keep a close eye on the notifications that usually get sent by your medical aid when a claim is submitted. If you get a claim notification for something you are unaware of, you need to immediately report it to your medical scheme,” says Mitchell. 

“Medical aid cards, unfortunately, unlike bank cards can’t be canceled when they are lost. The unique identifier is the member number which does not usually change when you remain with the same medical aid.”

READ MORE: How will your personal information be protected by your insurers?

Part of the responsibility for keeping your details secure lies with your medical aid scheme.

“Medical scheme companies have various data protection mechanisms. One of the mechanisms is to protect your medical aid information from third parties. They are not allowed to share your medical aid information with third parties unless they have a consent form from the member or a power of attorney,” says Mitchell.

“Medical schemes also ask security verification questions before they can share information with a member or someone acting on behalf of the member,” he adds.

Article originally published on JustMoney

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