Preventing, detecting and investigating suspicious claims

Wednesday, 6 April 2016 by Kelsey Fletcher

We have 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 unnecessary claims costs.

Southern Cross Health Society Head of Finance, Risk & Compliance Stefan Azzopardi says the vast majority of members and healthcare providers can be relied upon to act honestly and with integrity.

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

We’re encouraging anybody who is aware of suspicious claiming behaviours or irregularities affecting Southern Cross to confidentially call the dedicated hotline - 0800 420 055 - or email fraud@southerncross.co.nz