The Healthcare Forensic Management Unit (HFMU) is an information and resource sharing group which enjoys the participation of the majority of medical schemes, administrators, management and administration entities and some insurers.
The core focus of this unit is to facilitate a unified approach with regards to fraud in the medical schemes environment. This is achieved by sharing information regarding fraud, over billing and over servicing in order to minimise fraud across the industry and to protect medical schemes from healthcare providers and medical scheme members who shift their wrongdoings from one medical scheme to another once “caught out”.
The HFMU is co-ordinated and administrated under the auspices of The Board of Healthcare Funders of Southern Africa and is unique in that it is the only initiative of its kind within the healthcare industry.
The benefits of participating in the HFMU includes, but are not limited to, working within a strict legal framework to ensure a fair and transparent approach; no duplication of efforts; collaboration with professional and international bodies; a more streamlined process with criminal matters due to newly formed relationships with the likes of the SAPS, NPA and the various prosecuting authorities; regular training workshops and much more.
The unit is committed to zero approach to fraudulent activities in the healthcare industry.
HFMU STRUCTURE
- SA Medical Schemes represented
- Forensic companies represented
- Insurance companies represented
- Managed Care Organisations represented
- Medical Scheme Administrators represented
The HFMU Online Portal is a secure contributory database where a participant can upload information on FWA investigations so that other participants are alerted of FWA activity in relation to a specific beneficiary and / or healthcare service provider. This serves inter alia as a preventative strategy to other medical schemes to investigate a similar FWA trend so captured.
