In this episode, we discuss fraud, waste, and abuse in healthcare, specifically within the GEMS medical aid scheme. Host Uveka Rangopa speaks with guests Ishmael Mogapi (GEMS Senior Manager, Operations Risk), Nomfundo Dhlomo (Head of JIMS Claims Risk Management), and Dr. Gregory Pratt (Head of Claims Risk).

The discussion begins by defining fraud, waste, and abuse in healthcare. The panel then speaks about the significant financial impact on medical schemes and shares concerning trends. They discuss the consequences and emphasise the importance of members protecting their medical aid details and reviewing claim statements, encouraging whistleblowing, and highlighting GEMS' improving analytical capabilities to detect fraud. GEMS on Facebook · Connect with GEMS · Follow GEMS on X · GEMS on Instagram

In this episode, the GEMS internal audit team talk about their role in providing assurance on risk management and governance for the medical aid scheme. The panel includes Bongani Bango (Senior Manager, Internal Audit), Vanessa Ngwenya-Ndlovu (Senior Manager, Internal Audit Finance and Operations), and Jules Nunes (Senior Manager, Internal Forensics), hosted by Uveka Rangopan.

The conversation explores the primary mandate of internal audit, which is to provide objective and independent assurance to help the organisation achieve its objectives by evaluating governance, risk management, and internal controls. The team explains how they maintain independence by reporting directly to the audit committee rather than executives, which allows them to work without undue influence. They discuss fraud in the context of GEMS, describing it as intentional actions against policies or legislation for personal or financial gain. The panelists share how they handle conflicts of interest, maintain objectivity, and the role of technology in combating fraud. They also cover the evolution of fraud techniques, particularly with the rise of AI and technology, and provide guidance on what employees should do if they suspect fraudulent activities, including documenting observations, gathering evidence, and reporting through appropriate channels like the Whistle Blow Hotline. GEMS on Facebook · Connect with GEMS · Follow GEMS on X · GEMS on Instagram

In this episode, we will discuss in detail how GEMS designs its benefit structure to ensure competitive advantage, what it takes to operationalise the business and continue providing excellent service to all beneficiaries. Uveka Rangappa is joined by GEMS’ Chief Operations officer Dr Vuyo Gqola, GEMS Chief Financial Officer Ms Karyna Van Lingen, and GEMS’ Executive Manager Ms Masingita Chavalala. GEMS on Facebook · Connect with GEMS · Follow GEMS on X · GEMS on Instagram

Join key decision makers at the Government Employees Medical Scheme (GEMS), including Dr. Stan Moloabi, Ms. Karyna van Lingen, and Ms. Malinda Lubbe as they provide an overview of GEMS, its history, purpose, affordability, financial sustainability, and future plans.

GEMS mandate is to provide comprehensive and affordable healthcare benefits to government employees. GEMS on Facebook · Connect with GEMS · Follow GEMS on X · GEMS on Instagram