Fraud & Claims

To protect patients and healthcare providers from fraud and unauthorized use of personal information, Tsheko Wellness Center follows a strict verification process:

1. 1Suspicious claims or activities are identified and flagged for review.
2. 2The affected patient may be contacted directly to verify their identity and confirm that the services claimed were received.
3. 3Supporting documentation may be requested where necessary.
4. 4A full investigation is conducted to determine whether fraudulent activity has occurred.
5. 5If fraud is confirmed, the matter may be reported to the relevant medical aid schemes, regulatory bodies, and authorities.
6. 6Patients who suspect their identity has been used without authorization should immediately contact our team.

Healthcare providers who experience issues with claim submissions, payments, rejections, or disputes can follow the process below:

1. 1Contact our claims support team regarding the claim in question.
2. 2Provide the relevant claim reference number and supporting documentation.
3. 3Our team will review the claim and identify any missing information or discrepancies.
4. 4Additional information may be requested where required.
5. 5Feedback and recommendations will be provided to assist with claim resolution.
6. 6Where applicable, corrected claims may be resubmitted for reassessment.
7. 7The final outcome will be communicated to the healthcare provider once the review process is complete.