The medical scheme industry in South Africa is competitive in relation to international standards. The medical scheme sector, as part of the healthcare industry, is negatively affected by the high rate of fraud perpetrated by providers, members and syndicates, which results in medical schemes funding fraudulent claims. The purpose of the study was to explore strategies to mitigate fraud in medical scheme claims. A qualitative research methodology was followed in this study, which adopted a case study approach. Empirical data was analysed through thematic analysis, with the aid of ATLAS.ti software. The study found that healthcare service providers mainly defraud medical schemes by submitting false claims. A holistic approach should be followed to mitigate fraud in medical scheme claims. This approach should encompass regularly identifying trends in fraudulent claims and implementing appropriate control strategies. Collaboration within the medical scheme industry and with other stakeholders would also help to elevate the fight against medical scheme fraud to a new level. Implementing the recommendations from the study will assist medical schemes to reduce the funds expended on fraudulent claims, thereby improving their financial viability and decreasing the rate of increase in medical scheme contributions for members. / Business Management / M. Com. (Business Management)

Tax crimes, money laundering and other financial crimes threaten the strategic, political and economic interests of developed and developing countries. The problems encountered by the researcher, is the broad and vague meaning of financial crime compounded by the confusing and ill-considered use of the term by law- and policymakers, politicians, government agencies, agency officials and practitioners weakening effective communication about the phenomenon. The literature shows that given the complexity and multi-faceted nature of financial crime, combating financial crime in all its facets cannot be undertaken by investigative agencies acting in isolation. This study was undertaken with the aim to describe and systematically categorise financial crime and evaluate the prospect of using a Whole-of-Government approach as a framework to harness the capacity of the existing government agencies to combat financial crime more effectively. The research was underpinned by a pragmatic paradigm allowing the researcher to apply a qualitative research methodology using an exploratory and evaluation research design. A detailed review of the literature available nationally and internationally was conducted to establish a conceptual and practical understanding of the issues under investigation. An interview schedule with predetermined questions was developed, pre-tested and administered to participants who are active practitioners involved in combating financial crime in the primary government agencies responsible for combating financial crime based on a purposive sample. The data obtained from the literature and participants were analysed, interpreted and thematically listed according to the frequency with the aim of identifying and comparing similarities and differences between the data. The data was used to develop a system to categorise financial crime systematically based on descriptors used to describe the meaning and application of the term financial crime and to propose practical methods practises and models to combat financial crime more effectively. This research indicates that financial crime can be systematically categorised according to descriptors of the unlawful conduct and that the whole of government approach is a viable approach to combat financial crime more effectively according to the available models for arranging Whole-of-Government work. / Police Science / D.Litt. et Phil. (Police Science)

The use of credit cards has become a way of life in many parts of the world. Credit cards have also created many new opportunities for criminal activity. It is in this light that organizations such as VISA International have explored a variety of security alternatives by constantly reviewing security measures that may be applied to cards and devote considerable resources to the maintenance of security systems and programmes. These programmes mandated by the association, include uniform card standards, security standards for manufactures, embossing and encoding of cards, standards for mailing the cards and credit background investigations of applicants. These standards assist investigators in examining counterfeit cards and distinguish a counterfeit card from a genuine card. The constant reviewing of security features and methods by the association is to create a card that is technically difficult to alter or counterfeit. / Criminology and Security Science / M.Tech. (Forensic Investigation)

The aim of this paper is to research how advanced accounting software can be used by police detectives, financial risk specialists and forensic investigation specialists, who are responsible for the investigation and tracing of the reintegration of proceeds of crime, from underground banking into formal banking system (pro active and reactive money laundering investigation) with a view on criminal prosecution. The research started of by looking at the basic ways how proceeds of crime are smuggled before it is integrated into the formal banking system. In that context, the phenomenon of Underground banking was researched. Currency smuggling, Hawala currency transfer schemes and the way in which it is used to move proceeds of crime were discussed in detail. Thereafter Formal banking and the way in which proceeds of crime is reintegrated from underground banking structures into formal banking systems were discussed. The use of advanced accounting software to trace the point where proceeds of crime are reintegrated into formal banking were researched extensively. Accounting software and investigative techniques on how to trace financial transactions which might be tainted with proceeds of crime were discussed. Accounting software which can be used on office computers such as laptops were discussed and more advanced automated systems which can be used to trace proceeds of crime transactions in the formal banking systems were also discussed. In specific, the investigative techniques on how to use these systems as investigative tools were discussed in great detail. This research paper gives a truly unique perspective on the financial investigative and analytical angle on proceeds of crime and money laundering detection. / Criminal Justice / M.Tech. (Forensic Investigation)

It is a well-known fact that criminals derive an income from their illegal activities, live lavish lifestyles, flaunt their wealth for all to see and acquire luxury goods. It is also a well known fact that criminals living from the proceeds of crime do not want to not want to keep financial records of their transactions or illegitimate business for fear of being detected by the authorities and to escape being taxed. It is also a known fact that criminals do not declare income from criminal activities for income tax purposes to the revenue authorities for fear of the illegal origin of the income being made known to the investigating authorities and law enforcement. During the investigation of financial crimes, such as tax evasion and money laundering, it may be required that the amount or value of money, income or assets accrued by a subject is determined in order to determine for instance their liability to pay tax. This research project examines the Net Worth method as an indirect method to circumstantially quantify income during the investigation of financial crime. / Police Practice / M.Tech. (Forensic Investigation)