The Council for Medical Schemes (CMS) is a statutory body which regulates medical schemes and related entities. In fulfilling part of its regulatory mandate, the CMS is looking at mechanisms to address the scourge of fraud, waste and abuse in the medical schemes industry.
In fulfilling part of its regulatory mandate, the CMS is looking for mechanisms for addressing the scourge of fraud, waste and abuse in the medical schemes industry. As such, these call for collective action from all role players, such as medical schemes, administrators, managed care organisations, policy makers and other organisations. As a regulator, it is fitting for CMS to be at the forefront of any interventions against fraud, waste and abuse.
As an entity mandated with the protection of the interests of members of medical schemes in terms of the Medical Schemes Act, No. 131 of 1998; the CMS is committed to working together with all industry role players to resolve the issue of fraud, waste, and abuse in the sector.
What are the deliverables of FWA summits?
To deal with fraud, waste and abuse for industry sustainability by:
CHARTER
The signing of an industry agreement or charter where all stakeholders pledge to contribute to combating fraud, waste and abuse, in line with set standards. During the inaugural summit in 2019, a Charter was signed by role players in the industry. Access the Charter here. The review period for the FWA charter is every two years.
INDUSTRY STANDARDS
Establishing standards for the industry to effectively deal with fraudulent activities. The 2022 Fraud, Waste and Abuse Webinar continued the work to establish Codes of Good Practice and Standards for the industry to effectively deal with fraudulent activities. This includes fair sanctions for convicted fraudsters through the establishment of an FWA Tribunal.
PERMANENT FWA STRUCTURE
The establishment of a structure to continuously deal with fraud, waste and abuse post the summit.