A mere 16 percent of the population enjoys the benefits of private healthcare; medical schemes however remain an important contributor to the South African economy with an annual contribution flow of close to R85 billion per annum. Similar to the international scenario, South African healthcare inflation surpassed consumer price inflation. In addition, the medical schemes industry remains riddled with fraud, this coupled with escalating private healthcare costs remain subsequent threats to the sustainability of the industry. It is reported that service provider fraud has surpassed fraud committed by scheme members. Most medical schemes appear to have policies in place to manage and combat fraud, however transparency in terms of information sharing remains elusive. Of greater concern have been the investigation and management ethicality and endgame of medical schemes in terms of fraud risk management amongst medical practitioners. The research problem states that there is currently no standard fraud investigation and management protocol available for the ethical investigation and management of medical schemes fraud committed by medical practitioners. The literature review demonstrated that there has been a paradigm shift regarding the expectations that society has of the modern corporation and emphasised the inclusive stakeholder model theory in favour of the traditional shareholder dictum: pursuit of profit maximisation at any cost. The research design was done by providing a survey questionnaire to private medical practitioners. The literature review and survey findings highlighted the need for medical schemes to pay greater heed to their ethicality and stakeholder issue management practices. Focus areas for the development of an industry standard fraud investigation and management protocol was recommended.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nmmu/vital:8895 |
| Date | January 2013 |
| Creators | Titus, Phyllis May |
| Publisher | Nelson Mandela Metropolitan University, Faculty of Business and Economic Sciences |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis, Masters, MBA |
| Format | xiv, 109, [11] leaves, pdf |
| Rights | Nelson Mandela Metropolitan University |
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