Prime Cure Forensic Department

Should you suspect any dishonesty or fraudulent act or something you feel is unusual please fill in the form below:

Prime Cure Online Fraud form
click here to submit form

We have a dedicated 24- Hour Prime Cure Fraud “Hot Line” please call us on 012 665 8588, Fax us on 0865 571 909 or email us @ Forensics@primecure.co.za

Providers

Stop Medical Aid Card Fraud  

Your rights and obligations

We have all heard the words “beware of membership substitution” but just what does this mean?

In a nutshell it refers to the unlawful and fraudulent use of a Medical Scheme Card in order to obtain benefits to which the user is not entitled.

What are the motives for doing this?

It could literally be anything ranging from greed to economic need, culture entitlement and pressure to assist a family member or even a neighbour in need. Another common reason is the mistaken notion that “everyone else is doing it!”

For hospital admission, consultations or any benefit utilisation be sure to follow these guidelines in order to eliminate possible fraud. You have the right to check and question.

• Always ensure that the member produces a valid medical scheme card and NOT a photocopy

• An original identity document and NOT a photocopy is needed • During a first consultation a registration form should be completed in full and signed by the member.

• In the case of a minor the form has to be completed in full and signed by a responsible person accompanying the minor

• Copies must be kept by the provider in a member file for reference purposes

• Should the provider’s practice management system issue an account before the member leaves the provider’s premises, the member/patient has to sign the account

As a provider you have a legal and ethical obligation to report fraud and abuse and to ensure that the benefits authorized by Primecure are used for the benefit of its “REAL “members. If you suspect a member is or may be committing a fraudulent act, please contact the following ;

Fax us on 0865 571 909 or email us @ Forensics@primecure.co.za  

Members

Help Primecure Stop Providers that commit FRAUD 

Prime cure’s objective is to curb the incidences of fraud and other inappropriate behavior and build members’ awareness.

Primecure actively investigates all allegations and “Tip Off’s “of Fraud, eg Unethical Behaviour and Abuse over servicing in the utilization of benefits: If you suspect fraud by a fellow member or healthcare provider report this information to the Primecure Forensic department using the contact details below: you may remain anonymous, or you may choose to give your personal details.

Please take the opportunity to scrutinize your paid claims on the member log in.

Check the following information on the claim;

• Membership details > the details of the patient

• Name and the dependant code

• The name of the health care provider that submitted the claim

• The date when the health care provider rendered that service (date when consultation, treatment or investigation took place)

• Should you be in any doubt that this information is incorrect please report to the contact details on this page; alternatively report to the Prime Cure call centre 0861 665 665 Where you will be assisted by a Service Center Agent

Alternatively: Fax us on 0865 571 909 or email us @ Forensics@primecure.co.za  

Remember the following and to tell your dependants that are eligible to receive benefits on your medical aid.

• Never lend your medical aid card this must only be used by the persons’ whose names are on the card and are eligible for benefits.

• Never leave your medical aid card with a provider this must be kept in your possession at all times

Listed below are some examples of Fraud committed by HealthCare Providers and Members.

• Billing for services not provided