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Business Reporter
Cimas Medical Aid Society has put in place measures to ensure that all drug claims are processed expeditiously. This follows its decision to suspend its online drug payment facility as a result of an upsurge in fraudulent claims. In addition, claim forms are being collected twice a day from designated collection points. The capture of the data on these forms is being given priority.
A Cimas spokesperson said the inconvenience to members of suspending the online facility was regrettable but unavoidable.
This is due to the fraudulent activity which had seen drug claims increasing by more than a million dollars in the first three months of this year, when compared to the same period last year.
“During the first quarter of 2014 we spent $2,2 million on drugs for 205 000 beneficiaries.
“In the first quarter of 2015, with a reduced membership of 202 000 beneficiaries and reduced cost of drugs, we incurred a $3,4 million drug bill.
“That is a difference of $1,2 million in just three months, or an increase in drug costs of 54 percent,”he said.
“Our online drug facility has been of great benefit to our members. However, the efficient functioning of this facility is premised on several assumptions, including that members are careful and vigilant with their prescriptions and regularly check their statements to verify the drug claims on them and that pharmacies verify the identity of members accessing drugs from them,” the spokesperson said.
He said there was an instance of fraud recently when a woman used a stolen Cimas membership card to buy the same drugs from three different pharmacies.
When the police asked her what she intended doing with them, she said she intended to sell them in Mbare.
She had already made an unsuccessful attempt to obtain the drugs from another pharmacy using the stolen Cimas card but disappeared when
she was unable to produce an identity card and the pharmacist phoned Cimas to ask whether he could accept the claim.
When arrested she was found to have numerous medical aid cards from different medical aid societies.
However, that is not the only type of fraud that Cimas is up against. There have been discrepancies between the online claims made by some pharmacists and the hard copy prescription forms.
Online Reporter