In September, the Health Funds Association of New Zealand (HFANZ) announced that its members, including Southern Cross, had agreed to set up an integrity register managed by PricewaterhouseCoopers. The register would be used to tackle fraud and undesirable billing practices, and help manage the rising cost of healthcare.
According to HFANZ, the register will be able to identify the estimated 3 to 5 per cent of health insurance claims believed to be fraudulent. The total cost of fraudulent claims across the health insurance industry, deliberate and non-deliberate, is estimated to be about $29 million per year. Southern Cross doesn’t see a high level of fraudulent activity, whether it is deliberate or non-deliberate. However, our claims centre in Hamilton receives a variety of invoice types from providers and members, which claims assessors occasionally need to follow up to validate and check for duplication.