Masterclass 2: Healthcare-related Fraud, Waste and Abuse (FWA)
Overview
The second Healthcare Law & Policy Masterclass examined the growing challenge of fraud, waste and abuse within the healthcare sector. Bringing together legal, forensic and healthcare specialists, the session provided participants with a deeper understanding of the regulatory framework governing healthcare fraud investigations and the practical strategies employed to detect, prevent and respond to misconduct.
The masterclass highlighted the importance of robust governance, forensic integrity and cross-sector collaboration in protecting healthcare resources.
Key Topics Covered
Regulatory Framework
Participants explored the legislative and regulatory environment governing fraud, waste and abuse investigations, including section 59 of the Medical Schemes Act, relevant provisions of the Prevention and Combating of Corrupt Activities Act (PRECCA), and applicable common-law principles.
Operating a Healthcare Forensics Function
Presenters shared practical insights into the management of healthcare forensic units, including investigative processes, governance structures and operational best practices.
Integrity of Investigations
The session examined the ethical and procedural requirements necessary to ensure fair, credible and legally defensible forensic investigations.
Categories of Fraud, Waste and Abuse
Participants reviewed common examples and categories of healthcare-related fraud, waste and abuse, including provider misconduct, billing irregularities, corruption and fraudulent claims.
Enforcement and Risk Mitigation
Discussions focused on mechanisms for identifying risks, strengthening compliance frameworks and implementing preventative measures within healthcare organisations.
Presenters
Marius Smit
Head, Discovery Health Forensics Unit
Stephan Jacobs
Legal Advisor, Discovery Health Forensics Unit
Steven Powell
Executive and Head of Forensics, ENS Africa
Adrian Roux
Senior Associate, ENS Africa
Facilitator
Prof Victoria Bronstein
Professor, University of the Witwatersrand
The masterclass took place on 1 July 2025.