In a move to combat fraud and to strengthen internal control systems and security, a leading medical aid society in Zimbabwe plans to introduce biometrics to safeguard member funds.
Biometrics are technologies that are used to identify and authenticate human body characteristics, like; voice patterns, fingerprints, facial recognition and eye retinas.
In Zimbabwe medical aid schemes lose close to $200 million annually through fraud. Card loaning is one type of fraud that is a major cost driver for funders.
Card loaning is driven by the patient and the provider colluding or either party acting independently.
“The worst for me was a 20 something year old bringing their 60 year old mother and giving them their card,” says Cimas Group Chief Executive, Vulindlela Ndlovu.
This nonetheless, can be significantly reduced if not eradicated with the employment of biometrics to verify that the right patient is being attended to by the service provider according to the details registered on the system.
According to the Chief Executive Cimas Medical Aid Society is planning to link members’ fingerprints to membership cards to ensure that more funds get used on patient care in addition to combating the problematic levels of card loaning in Zimbabwe.
“We are now going into the biometrics, so far that’s the only method that’s probably admitted to be quite good in terms of curbing card loaning, so we are going into the biometrics where you will need to use your finger,” said Mr Vulindlela Ndlovu.
Membership card fraud has reached alarming levels in Zimbabwe, as some members are using their cards to purchase groceries.
“I have actually seen someone using a Cimas card like an ATM card, someone bought meat,” said, Thando Kembo the Cimas Group Internal Auditor, at an Insurance Journalist Mentorship Program hosted by ZimSelector.com.
“So you go to a butchery you give them your Cimas card and maybe the butchery owner has a pharmacy so they will submit a claim to Cimas for the equivalent (of the meat purchased),” she added.
Though still in the planning phase, the system promises to reduce such kind on incidences.
Biometric membership cards work in such a way that when a patient seeks treatment, healthcare providers will be able to identify and authenticate that they will be treating the right person. Biometrics also show proof of presence and ailment treated so that the Medical Aid Funder can actually know that the patient was there, and claims automatically processed. Making it much harder for service providers or patients to submit fraudulent medical claims.
As Cimas is awaiting biometrics the medical aid society has put in place control systems to minimize card loaning, Currently Cimas had been using a membership card with the members’ identity picture. Cimas has also put in place control systems that ensure that a member accompanies their claim form at all stations from the reception to the doctor.
“Previously you just presented your claim form at the reception, and what people then tended to do is when they go to the doctor, they then say it’s this one (non-member) who is being treated,” Kembo said.
The Group Internal Auditor said that combating fraud is always challenging and people always find more creative ways to beat the system. However, Cimas is always looking for ways to combat fraud.
“As we said we are always continuously learning, you know we won’t say we are like the best medical aid our controls are on point, whenever something does come up we change and improve our controls to make sure that these malpractices are nipped in the bud, so to say,” stated Kembo.
“We are also engaging global players, so that we are also aware of what other people out there are doing, and we can look out and safeguard the fund at Cimas to ensure that our funds are not needlessly leaked,” she said.
“As an institution we are revamping our forensic and investigation unit to make sure that we are better equipped to combat fraud. We also investing quite a lot to make sure that we minimize the impact, we are still on top of our game,” added Mr Ndlovu.
Given the soaring costs of healthcare fraud in Zimbabwe, biometric systems are the future. In Africa amongst other countries, biometrics in health care are used in Namibia, South Africa, Mali, Gabon, and Kenya.