Fight fraud to keep the cost of healthcare down

Fraud affects everyone, even people who are not members of medical schemes. Fraud drives up medical inflation which means medical care and your medical scheme contributions go up more than they would otherwise. Most members and healthcare providers are honest; only a few dishonest people are responsible for the problem.

Fraud happens when someone intentionally lies or twists the truth for financial gain. Unfortunately, this happens to medical schemes when, for example, a doctor claims for a service they did not deliver or a pharmacist charges for a brand-name medicine but dispensed the generic instead and keeps the extra money.

People who commit fraud do not just steal from BMW Employees Medical Aid Society, they steal from you and other members. We put your monthly contributions together and pay claims from the pool. Help us pay as many claims as possible by reporting fraud. You don't have to give your name. All you have to do is tell us if you suspect fraud.

Be on the lookout for these kinds of fraud

Merchandising

By law, the Society only pays for specific healthcare items such as medicine and prescription glasses. Claiming for general wellness items like sunglasses, nappies or sport supplements from the Society is a crime.

Card farming

We only budget for our members' medical expenses. It is illegal to allow a non-member to use a member's card for medical treatment or medicine.

Cosmetic surgery

Most medical schemes don't pay for cosmetic surgery because they are optional procedures that don't directly affect members' health. It is unlawful to claim for cosmetic surgery under another procedure code.

ATM scams

A healthcare provider and a member can work together to attempt to steal money from BMW Employees Medical Aid Society. The provider sends a claim for a service the member didn't receive or overcharges for the service they gave, and they pay the member for taking part in fraud. This is called an ATM scam because the member withdraws money from the Society.

What can you do to fight fraud?

  • Check your claims and statements. Ask your healthcare provider for a copy of your claim and read it to make sure that it only lists services you've received.
  • Keep your membership card safe. Don't give your card to anyone who is not a member.
  • Be careful if a healthcare provider says that they "can make a plan". Don't accept any offers to make the amount you have to pay yourself less on any service or item.
  • If you've just joined the Society, tell us about any medical conditions you already have.
  • Tell us if someone approaches you with an idea to steal money from the Society or if you know of someone who is committing medical aid fraud.

Use our anonymous fraud hotline to report fraud

We don't have to know who you are to take your report seriously. If you even slightly suspect someone of committing fraud, report all information to our fraud hotline. You can remain anonymous if you prefer:

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