About Good Returns  |  Advertise  |  Contact Us  |  Terms & Conditions  |  RSS Feeds Other Sites:   tmmonline.nz  |   landlords.co.nz
Last Article Uploaded: Thursday, November 14th, 3:52PM
rss
Latest Headlines

Southern Cross tackles fraud

Southern Cross has launched a phone line for people to dob in those they suspect of insurance fraud, but it says it does not have any concerns about advisers.

Wednesday, November 25th 2015, 6:00AM

Stefan Azzopardi, head of finance, risk and compliance for Southern Cross Health Society said, “The vast majority of members and healthcare providers can be relied upon to act honestly and with integrity - however, claiming irregularities for health insurance are real and the society won’t tolerate dishonesty.

“Common sense tells us that when we’re paying 73% of the country’s health insurance claims, we need to be vigilant as any unnecessary costs are ultimately met through premiums.”

The society has a specialist team dedicated to preventing, detecting and investigating suspicious claims, whether they involve deception, poor administrative practices or billing errors.

To date, the work from this team has saved members an estimated $1 million in ongoing annual claims costs - and investigations are often due to member tip-offs.

Azzopardi said advisers were not a problem for Southern Cross. “They tend not to get involved in the claiming process – a few take on  that extra responsibility but is so marginal it’s not an issue.”

He said international estimates were that up to 3% of health insurance claims were fraudulent, which would equal up to $20 million in claims costs a year in New Zealand. “That’s quite a significant number.”

Tackling that would reduce the cost to other members, he said.

Fraud was most often things such as altered invoices from members, or suspicious coding from providers who might submit a claim with a code for a more expensive procedure than the one they carried out.

“While the most obvious claims brought to our attention involve members who file claims for services or medications not received, or submit altered bills or receipts – billing and administration practices by a small number of medical providers have also posed challenges.

“With medical providers, given the potential patient volumes, claims we investigate can involve large sums and pose a much greater financial risk to the society,” he said.

Azzopardi said anybody who is aware of suspicious claiming behaviours or irregularities affecting Southern Cross to confidentially call the dedicated hotline - 0800 420 055 - or mail fraud@southerncross.co.nz

Tags: health insurance Southern Cross

« FSC report a missed opportunity: NaylorHealth insurance bill defeated »

Special Offers

Comments from our readers

No comments yet

Sign In to add your comment

 

print

Printable version  

print

Email to a friend
Insurance Briefs

Suncorp invests in wellbeing
Suncorp New Zealand has now invested a total of $20 million into wellbeing bonds as part of its focus on identifying sustainable investment opportunities that can deliver positive community outcomes.

AIA adds mental health support
AIA is boosting Vitality members’ donations to the Mental Health Foundation.

Major milestone for Cigna
Cigna, which acquired OnePath Life last year, is on the verge of reaching "a huge milestone".

Fidelity Life gets tick
Fidelity Life has been awarded the Accessibility Tick.

News Bites
Latest Comments
Subscribe Now

Cover Notes - Specific news aimed at risk advisers

Previous News

MORE NEWS»

Most Commented On
About Us  |  Advertise  |  Contact Us  |  Terms & Conditions  |  Privacy Policy  |  RSS Feeds  |  Letters  |  Archive  |  Toolbox
 
Site by Web Developer and eyelovedesign.com