DEFENCE FORCES MEDICAL INSURANCE SCHEME

Your Health Care Partner in Retirement

STAY ALERT! Protect Yourself from Insurance Fraud

FRAUD AWARENESS & PREVENTION

Protecting DEFMIS Members from Insurance Fraud

What is Insurance Fraud?

Insurance fraud occurs when someone deceives an insurance scheme to gain unauthorized benefits or financial gain. At DEFMIS, we are committed to protecting our members from fraudulent activities and ensuring the integrity of our services.

Common Fraud Schemes to Watch Out For

Impersonation Calls

The Scam:

Fraudsters call pretending to be DEFMIS officials, requesting personal information, card numbers, or OTP codes.

Red Flags:
  • Requests for your DEFMIS card number or PIN
  • Asking for OTP codes over the phone
  • Urgent demands for personal information
  • Threats of benefit suspension

Fake Billing & Inflated Claims

The Scam:

Healthcare providers submit false or inflated bills for services not rendered or exaggerate treatment costs.

Red Flags:
  • Bills for services you didn't receive
  • Duplicate billing for same service
  • Pressure to accept unnecessary procedures
  • Hospitals requesting cash payments for covered services

Card Sharing & Misuse

The Scam:

Members allow non-dependants to use their DEFMIS cards or sell access to their benefits.

Red Flags:
  • Someone asking to borrow your card
  • Offers to "rent" your benefits
  • Using another person's card for treatment
  • Sharing OTP codes with others

Phishing & Fake Communications

The Scam:

Fraudulent emails, SMS, or websites impersonating DEFMIS to steal personal information.

Red Flags:
  • Emails from non-official domains
  • SMS requesting you to click suspicious links
  • Fake websites that look like DEFMIS portal
  • Requests to verify account via email/SMS

Ghost Patients & Staged Treatments

The Scam:

Hospitals claim treatment for patients who never visited or stage admissions for healthy individuals.

Red Flags:
  • Claims for dates you weren't at the facility
  • Admission records you don't recognize
  • Hospitals offering "free" admission schemes
  • Pressure to stay admitted without medical need

Identity Theft

The Scam:

Criminals steal member identities to access medical services or sell personal information.

Red Flags:
  • Claims you didn't make appearing on your account
  • Unfamiliar hospital visits on your record
  • Sudden changes to your registered details
  • Notifications for services you didn't request

How to Protect Yourself

Do's

  • Keep your DEFMIS card secure - Never share it with anyone
  • Verify all communications - Call official DEFMIS numbers to confirm
  • Review your statements - Check for unfamiliar claims regularly
  • Use official channels only - Visit defmis.org or call verified numbers
  • Clear all visits with OTP - Always complete the clearance process
  • Report suspicious activity immediately
  • Keep your contact details updated
  • Visit only accredited hospitals

Don'ts

  • Never share your OTP codes with anyone
  • Never lend your DEFMIS card to non-dependants
  • Don't click suspicious links in emails or SMS
  • Don't share personal information over phone/email
  • Don't accept "free" treatment schemes that seem too good to be true
  • Don't sign blank claim forms
  • Don't agree to unnecessary procedures for financial gain
  • Don't ignore unfamiliar charges on your account

Official DEFMIS Contact Information

IMPORTANT: Only trust communications from these official channels:

Website: defmis.org

Portal: portal.defmis.org

Verification Hotline: 0793531197 / 0793666333

Email: info@defmis.org

REPORT FRAUD IMMEDIATELY

If you suspect fraud or have been a victim, report it immediately. Your vigilance helps protect all DEFMIS members.

Call Us

0793531197
0793666333

Email Us

fraud@defmis.org

Visit Us

Nyayo House, Nairobi

Consequences of Fraud

Engaging in insurance fraud is a serious offense with severe consequences:

  • Immediate withdrawal of benefits for the member and their dependants
  • Legal prosecution under Kenyan law
  • Criminal record affecting future employment and services
  • Financial liability - repayment of fraudulently claimed amounts
  • Expulsion from DEFMIS with no refund of contributions
  • Blacklisting from other insurance schemes