The Healthcare Forensic Management Unit (HFMU) is an information and resource sharing group which enjoys the participation of the majority of medical schemes, administrators, management and administration entities and some insurers.
The core focus of this unit is to facilitate a unified approach with regards to fraud in the medical schemes environment. This is achieved by sharing information regarding fraud, over billing and over servicing in order to minimise fraud across the industry and to protect medical schemes from healthcare providers and medical scheme members who shift their wrongdoings from one medical scheme to another once "caught out".
Participants can request that other users provide them with information. The request will be distributed to all HFMU participants, and members can provide feedback on the system in the tab where it states, "provide feedback on request".
Participants can load cases which they have investigated and have confirmed that the perpetrator is guilty of fraud or misconduct. In the event where the matter has been taken further (e.g. saps case, hpcsa etc.), participants will be able to provide an update on the status of the case once the outcome has been received.
Lookup providers and provider numbers linked to providers. Also a monthly report of all newly registered provider numbers.
All investigation cases which have been uploaded by members will be available on this tab for members to view.
Exposure analysis on shared claims data.
Receive daily notifications on all portal activity.