'Cimas Medical Audit Unprofessional'

CIMAS, one of the country's biggest medical aid societies, has come under fire from its members for violating their right to privacy and confidentiality after it enlisted the services of private investigators to assist in carrying out forensic audit against Corporate 24 Hospital Group.

The forensic audit was initiated after CIMAS suspected that Corporate 24 had submitted fraudulent claims, allegations that the latter denied. Disgruntled members who spoke to The Herald on condition of anonymity claimed that the investigators were asking them whether they received services from Corporate 24, if so of what nature, what was the treatment given and the tests conducted.

"I got people at my gate yesterday (Monday) in the evening with a truck and they started harassing me, asking me about Corporate 24 claims and shortfalls I paid.

"They were using a Safeguard vehicle and had a box of claims," said one of the members visited by the investigators. "They further interrogated me asking private questions such as the nature of services I received from the institution. It was a very uncomfortable moment," said one of the Cimas members visited.

'Cimas Medical Audit Unprofessional'

Another member visited by the investigator said while the society had a right to get to the bottom of what transpired at Corporate 24, the manner in which the investigation was being done was highly unprofessional.

"The most they could do is just ask members concerned if the signatures on the claim forms were theirs instead of getting into the nitty gritties of a patient's history.

Other members interviewed argued that by forwarding their claim forms to a third party without their consent, the society breached patients' right to privacy and confidentiality.

"Cimas has given our records, which are supposed to be private and confidential to third parties without our consent. We would like to know which law of the land empowered them to do so," said another member who also spoke on condition of anonymity.

Cimas group marketing and communications executive Mrs Nyengeterai Mahaka said the relationship between a service provider and themselves was based on mutual trust.
She said when that trust is abused, they are left with no option, but to take corrective action to not only stop the abuse, but also to ensure that it does not happen again.

"Due to the complexity and extensive nature of the audit, it has been necessary to involve both qualified auditors and investigators. The investigators are qualified and they have all been properly commissioned to conduct the exercise. The investigators have a letter of authority from Cimas to enquire on its behalf when conducting interviews," said Mrs Mahaka.

She said since the beginning of the exercise there has been no complaint to Cimas with regards to abuse of any member's confidential information.

"To the best of our knowledge, there has been no complaint to Cimas suggesting that any member's confidential information has been abused. Cimas does not have access to members' medical files. The information being used is only information that is necessary for a proper investigation into the matter and validating the existence of a legitimate claim," she said.

Mrs Mahaka said the audit was confined to disputed claims submitted by the provider. She said preliminary indications are that Cimas was prejudiced by irregular and in some instances fraudulent activities.

CIMAS once hogged the limelight in 2002 after a new system the medical aid introduced was roundly condemned by doctors, its members and the Government for violating patients' right to confidentiality.

The pre-notification system allowed third parties to have access to patients' records.