David Chisunga, Norazida Mohamed, Lisa Dambamuromo, Abel T Gwanzura, Jamaliah Said
The healthcare industry in Zimbabwe is competitive in reference to international standards. The medical insurance, as a part of the healthcare industry, is adversely suffering from the high rate of double billing fraud perpetrated against them and this leads to the societies funding fraudulent claims. The aim of the study was to investigate fraud detecting techniques that are employed in Zimbabwe’s health insurances in stopping double billing fraud. A quantitative research methodology was followed during this study, which adopted a survey research approach. With the assistance of PASW Statistics 18 software and NVivo 11, the empirical data was analyzed. The study revealed that the present fraud detecting techniques employed are ineffective within the detection and prevention of double billing fraud. Consequently, ineffectiveness in detection and prevention of double billing fraud has led to an increase in costs due to inflated claims, increased costs of operations realization of less revenue from insurance premiums, reputational damage among other effects. An all-inclusive approach should be followed to detect and alleviate double billing fraud against these societies. This approach should encompass a budget which should be allocated by the societies to teach and make awareness about the causes and effects of double billing fraud to employees, members, and service providers. A specialized team of research and developers must be established by the Association of Healthcare Funders in Zimbabwe to further look into double billing fraud and proffer new solutions in the fight against such fraudulent acts. There should be a continuous development of better detecting systems which prevent double billing fraud perpetrated against the Medical Aid Societies. Implementing the recommendations from the study will assist healthcare funders to scale back the funds exhausted on fraudulently billed claims, in turn improving their financial feasibility, and decreasing the financial contributions for members.