“SA's private healthcare sector is haemorrhaging up to R28bn a year due to rampant fraud, waste, and abuse (FWA), a practice that directly threatens the quality of care and financial stability of medical cover for millions of citizens,” reported Business Times (17 August 2025).
According to Health Funders Association (HFA), the losses represent 15% to 20% of all annual medical aid claims, said Thoneshan Naidoo, CEO of the HFA.
If fraud, waste and abuse can be reduced by even a third, that money could fund thousands of additional procedures, treatments and preventive interventions, saidNaidoo.
An estimated R10bn are annually lost due to fraud, R12bn due to waste and R4bn – R6bn to abuse.
Meanwhile, Artificial Intelligence (AI) are emerging as a critical tool for flagging suspicious claims.