Fraudulent use of medical aid by client
Question
I am an optician who accepts medical aid patients. A patient consulted and ordered a set of spectacles, and paid using the medical aid of another person. The medical aid paid my practice in full. It is only now that we have discovered that the medical aid was fraudulently used. How should I rectify the matter?
Answer
In the queried scenario, you as the optician charged a consultation fee and sold a set of spectacles to the client. This was a transaction between you and the client, for which the client was liable to settle the bill. However, the debt was transferred over to the medical aid company and the medical aid company settled the debt on behalf of the actual medical aid card holder, or one of their dependants. It was later discovered and verified that the medical card was fraudulently used by the client.
In other words, the debt was not settled on behalf of the client that transacted directly with you. Therefore, the medical aid pay-out that you received (due to the client’s fraudulent use of another member’s card) should be returned to the medical aid company, and the client that transacted with you will be liable to settle your account.
You should keep the spectacles in your possession until you receive the payment in full from the client/patient that ordered them.
- Answered by
- Mufti Mohammed Desai
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