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Stanford Sisya

Oliver Kazunga Senior Business Reporter
FIRST Mutual Health could be losing thousands of dollars to fraudulent claims by relatives of subscribed members who are not authorised to benefit from the scheme.

In a circular to members yesterday the firm’s general manager Stanford Sisya said fraudulent use of the health scheme cards has become rampant.

He warned members the trend may result in cancellation of one’s medical aid cover by the service provider. “We would like to bring to your attention incidents of fraudulent use of our medical aid cards by third parties posing as bona fide members of First Mutual Health,” said Sisya.

“In this regard, we wish to remind all our members that it’s unlawful to share medical aid cards with other people other than those authorised to use them, namely the primary member and nominated dependants.”

The health insurance firm said the abuse of the facility was not only fraudulent but may also “exhaust one’s medical benefits leaving them without cover when they require it most”.

He would not disclose details of the affected accounts but urged members to report as soon as possible to the nearest First Mutual Health office in the event that the medical aid cards were misplaced.

“Further to the above, members should always present their identity documents (national identity card, driver’s licence or passport) together with their medical aid card when seeking medical services,” said Sisya.

There is increasing suspicion that such abusive use of cards could be done with the blessing of some unscrupulous doctors.

An economic commentator, Sam Ncube said while he does not condone people to engage in illicit activities such as fraud, they were forced to do so by economic difficulties.

“It’s unfortunate that people aren’t being honest these days. But I think due to the economic difficulties prevailing in the country, people with medical aid cover are bound to engage in fraudulent activities. For example, if a member knows that a relative needs medical assistance and the relative isn’t on medical aid cover, people are bound to access medical assistance through fraud,” he said.

“I’m not condoning that people should commit crime because you can’t commit crime on the pretext that ‘I was trying to make a living.’”