Fraud Awareness

Fraud

 

  • False claim – death: Claims received for a death that has not occurred.
  • False claim – disability: A disability claim received where the life assured has not experienced any trauma and is not disabled according to the terms and conditions on his or her policy.
  • Forgery – Forging claim forms  
  • Non-disclosure: Not disclosing previous medical conditions and then attempting to claim for these conditions while on the policy.
  • Misrepresentation of unnatural death:
    • Suicide
    • Homicide
    • Hazardous Activities
  •  

 

  • False claim: Claiming for services that were never performed.
  • Card Sharing: Allowing a non-member to use the membership card for treatment.
  • Medicine Dispensing fraud: Where generic medicine is dispensed and the claim is received for the original drug at a higher cost.
  • Conniving with medical providers – receiving unnecessary medical treatment or getting payments for treatment not received

 

  • Exaggerating of claims: Submission of a valid claim, with inflated costs or additional items are added, which were never stolen.
  • Driving a vehicle whilst under the influence of alcohol or drugs: Falsification of state of mind when accident occurred.
  • False loss: Claiming for the loss of a specified item that the client never owned, or that was not really lost.
  • Causing further damage to items: A genuine loss occurred, however the client does not want the item repaired and causes further damage to the item in order to get a replacement.

TIP Offs

First Mutual subscribe to Deloitte’s Tip-Off Anonymous, a whistle blowing service

All Stakeholders are encouraged to report theft, corruption, fraud and inappropriate workplace behaviour.  The identity of the whistle-blower will be kept anonymous through a random number that is allocated.

Deloitte Tip Off Anonymous Hotline

Telephone Toll Free:       0800 1400 to 4106

Toll Free Econet:              0805 5500, 4461

Toll Free NetOne:            0716 800 189 /190 or 0800 4146

Email:                                    reportszw@tip-offs.com

Website:                              www.tip-offs.com

Postal Address:                 The Call Centre, P.O Box HG 883, Highlands, Harare