Martin Endjala
The Motor Vehicle Accident Fund was able to save itself from having to pay out millions of dollars in a fraudulent scheme the Fund detected.
The Fund has however lost N$847 406, of which the majority is related to medical treatment of persons who would otherwise not qualify as beneficiaries.
The MVA Fund recorded a total of nine fraudulent claims valued at N$3.6 million over the past five years of which four have been reported to the Namibian Police.
MVA Fund Chief Executive Officer, Rosalia Martins-Hausiku revealed that five cases are now also ready to be reported to the police, after preliminary internal investigations.
The fund has since recovered N$48 000 but no arrests have been made yet.
Martins-Hausiku stated that given the claims environment the Fund finds itself in, it is always susceptible to fraud.
Historically, fraudsters were specifically targeting the cash grants, especially the injury grant as well as payments towards loss of income and loss of support.
“We have seen a surge in medical-related fraud due to facts that have been tempered from the scene of the crash. Over the years the Fund has invested in detection mechanisms through various risk-mitigating strategies including capacity building, as well as the claims management system that assists in this regard, and we have seen a significant reduction in fraudulent activities after payment. The majority of the cases are detected at submission and stopped”, Martins-Hausiku said. When asked what methods the fraudsters deploy to defraud the Fund, she explained that these range from making false statements regarding injuries and the nature of a crash to getting access to medical treatment and inflated injury grant benefit pay-outs.
She further explained that sometimes it involves concealing the facts of an accident because they would otherwise be limited to certain benefits, falsification of income statements to get increased Loss of Income pay-outs and submission of false documents.
However, despite all this, she stressed that the Fund has a strong fraud management system in place, with personnel trained in fraud investigation. Due to the migrating nature of the fraud, they are also strengthening the capabilities of their Case Managers and Emergency Care Practitioners who are the first point of contact with off-crash scene information and in-hospital patients, Martins-Hausiku said.
In addition to continuous training of staff, there are also detection measures built into the claims management process which completes the fraud detection, management, and prevention strategy.
