Why a Fraud, Waste and Abuse Summit?
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.
This summit brings together stakeholders in the private healthcare sector including medical schemes, administrators, managed care organisations, policy makers, providers and other role players to discuss strategies for dealing with fraud, waste and abuse towards a sustainable industry.
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 work together with all industry role players to resolve the issue of fraud, waste, and abuse in the sector.
What are the deliverables of the Fraud, Waste and Abuse Summit?
To deal with fraud, waste and abuse for industry sustainability by:
The signing of an industry Charter where all stakeholders pledge to contribute to combating fraud, waste and abuse, in line with set standards. During the inaugural summit in 2019, role players in the industry signed an FWA Industry Charter. The review period for the FWA charter is every two years.
Establishing standards for the industry to effectively deal with fraudulent activities. This includes fair sanctions for convicted fraudsters through the establishment of an FWA Tribunal. The 2021 FWA Webinar will focus on setting the scene for Codes of Good Practice for industry, for the benefit of the member.
The establishment of a structure to continuously deal with fraud, waste and abuse post the summit.