CIMAS clamps down on fraudulent claims

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CIMAS Medical Aid Society is issuing new colour-coded membership cards to its 206,000 subscribers in a bid to reduce the number of fraudulent claims.
The society estimates that about 30 percent of the claims it received were fraudulent, with many of coming from non-members posing as subscribers by using a friends’ or relatives’ membership cards.
The new card carries the member’s photograph, making it more difficult for non‑members to use them.
In May, Cimas group chief executive officer Mac Chaora said as much as a third of the claims received by Cimas were suspect, with some members allowing non-members to use their membership cards to make claims from Cimas.
Chairman Mordecai Mahlangu recently also raised the issue of some members “being liberal with their card”.
He said that while they might feel this was an act of generosity on their part, it undermined the ability of the society to enhance benefits and maintain membership subscriptions at an affordable level.
Mahlangu also expressed the society’s concern over the recently gazetted increased doctors’ tariffs.
“We at Cimas recognise that, if we allow any of our costs to go up, our contributions will have to go up,” he said, adding that most members were already finding it difficult to pay current subscriptions.
Chaora warned members against allowing friends and relatives to use their membership cards.
“Unfortunately some of our members don’t seem to realise that the society is their society (and that its) resources are limited,” he said.
“If non-members, who are not paying anything to Cimas, make use of the services for which members are paying, that leaves less for the members themselves.
“Inevitably, if this trend continues, members will have to pay more. However, it clearly would not be fair for members to have to pay more to subsidise fraudulent claims from non‑members.
“While we continue to appeal to our members, therefore, to see the logic of this and to refrain from allowing non-members to use their membership cards.
“We have at the same time decided to make it more difficult for membership cards to be used by non-members by including the member’s photograph on the membership card.”Advertisement