BOMAID Hit By Fraud

Moraki Mokgosana
Botswana Medical Aid (BOMAID) has not been spared from the fraudulent activities as about 15% of its medical aid expenditure is a result of fraudulent activities.

Addressing the media recently, BOMAID chief executive officer Moraki Mokgosana said most fraudulent activities are done by members through over- utilisation of benefits, billing for services they have not rendered, identity theft and false claims.

“A widely held view is that about seven percent to 15% of most medical expenditure could be as a result of fraudulent activities by the members,” he said.

Mokgosana said this is a concern, which at times results in the delay of the processing of claims, as they have to verify each claim. He however stated that they have engaged experts to help address the fraudulent activities.Further he said that according to the latest Financial Global Health Database for 2017, it has emerged that government spends about $564 (P5 583,00) per person on health, followed by prepaid private sending with $319 (P2 158,00), development assistance for health $83 (P821,00) and out of pocket spending of $54 (P534,00).

He stressed the importance of having medical aid saying that it saves individuals money especially that unfortunate events that require medical attention when one least expect.

According to Mokgosana, out of Botswana’s 2.2 million people about 30% of the population does not have a

medical aid, while BOMAID has the largest number of members with about 35% while other medical aid schemes share the remaining 35%. 

According to the 2017 annual report of the Non-Bank Financial Institutions Regulatory Authority (NBFIRA), there are 10 licensed medical aid funds in the country with only one been exempted from licensing during the year under review.

It stated that accordingly, the development of medical aid funds regulations is in progress. Last year the regulatory authority issued every medical aid fund locally a waiver letter requiring the medical aid schemes to submit audited financial statements not later than four months following their respective year-ends.

“In the interim the medical aid funds are issued with exemption letter which granted the schemes permission to operate the business of medical aid funds whilst regulations are being developed,” read the report.

During the review period, the asset base and total liabilities of medical aids were P875 million and P272 million respectively compared to P784 million and P249 million recorded on the prior year.  This represented only half of the 10 medical aids funds locally, which the Authority said represent a challenge of reporting within the sector.




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