Fraud and abuse against the Fund


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Fraudulent and abusive behaviour against the Fund will not be tolerated. The Board of Trustees may exclude from benefits or terminate the membership of a member or dependant whom the Board of Trustees finds guilty of defrauding, abusing the privileges of or otherwise acting in a manner prejudicial to the interests of the Fund. In such an event the member may be required by the Board of Trustees to refund the Fund any sum which, but for the abuse of privileges of the Fund, would not have been disbursed on his/her behalf.

 

Members should note that the Fund reserves the right to implement the following procedures against members and/or healthcare providers guilty of fraudulent or abusive practices:

  • Criminal proceedings shall be instituted against the member(s) and/or healthcare provider(s), in the event of fraudulent claims
  • The Fund will institute civil litigation against the member(s) and/or healthcare provider(s) in order to recoup any money forfeited by means of such fraudulent acts
  • The membership of a member guilty of fraudulent practices will be terminated with immediate effect
  • In the case of the member being part of an employer group, the employer will be informed about the employee’s misconduct and fraudulent conduct
  • The names of member(s) and/or healthcare provider(s) guilty of such fraudulent behaviour shall be communicated to NAMAF for potential blacklisting with other medical aid funds

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