Cimas Medical Aid Society has suspended online drug claims after losing $1.2 million in fraudulent claims, with the society incurring a $3.4 million drug bill during the first quarter of this year compared to $2.2 million in the last quarter despite a fall in membership.
The society, which is the second biggest in the country by membership, said the issue came to light recently after a woman attempted to buy drugs using stolen cards.
“When arrested she was found to have numerous medical aid cards from different medical aid societies,” said Cimas in a statement yesterday.
“During the first quarter of 2014 we spent $2.2 million on drugs for 205 000 beneficiaries. In the first quarter of 2015, with a reduced membership of 202 000 beneficiaries and reduced cost of drugs, we incurred a $3.4 million drug bill. That is a difference of $1.2 million in just three months, or an increase in drug costs of 54 percent.”
Cimas said there were discrepancies between online claims made by some pharmacists and the hard copy prescription forms.
“Drug claims submitted by pharmacies electronically do not always tally with the physical hard copy of the prescription,” it said.
Some members were also allowing their relatives and friends to use their cards and that despite the cards having photographs of the holder, some pharmacies were not verifying the cards.
Members also receive a text message notifying them of their online drug facility transactions but few notified Cimas when they receive a notice about a transaction they had not made.
“I don’t think most of our members realise that it is their funds that are at risk and that fraudulent claims reduce the amount of money that is available to pay their legitimate claims,” said the company.
Cimas clients will now pay cash for drugs and the company said it would process claims ‘expeditiously.’- The Source
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