South Africa’s private health sector loses R30 billion annually to fraud, waste, and abuse

Minister of Health, Aaron Motsoaledi, revealed that South Africa’s private health sector has reported losses of R30 billion to fraud, waste and abuse in 2025.

Motsoaledi shared this information in response to a Parliamentary question by National Assembly member Thembinkosi Mjadu.

Mhlongo asked the minister about corruption, a lack of protection for whistle-blowers, and a failure to take decisive action against corrupt behaviour.

The Health Minister responded, providing details on the R30 billion annual loss in South Africa’s private healthcare sector.

He explained that these losses include claims for services not rendered and billing for brand-name medicines instead of cheaper generics.

There was also deliberate manipulation of billing codes, duplicate claims, and excessive charging for healthcare services.

Other problems include over-servicing patients through unnecessary tests or medication, and claims submitted on behalf of non-members.

Pharmacies were also guilty of claiming for medicine while dispensing non-medical items and cash-related fraud.

Reports from the Special Investigating Unit (SIU) Head Leonard Lekgetho also showed corruption risks identified by the Health Sector Anti-Corruption Forum.

These included doctors doing remunerative work outside the public service while neglecting their duties in state hospitals.

“In some cases, they even took their private patients into public hospitals for treatment,” Motsoaledi said.

“Other concerns were doctors deliberately referring patients for procedures in public hospitals to shield themselves from medical negligence claims.”

The Minister said that other corruption risks include procurement irregularities within health departments and counterfeit medicines and medical devices.

They also found bogus healthcare practitioners and anti-competitive practices such as price-fixing and fraudulent medical scheme billing.