An investigation into medical claims has exposed a well-orchestrated system of schemes to swindle the Department of Health out of millions of rands in fraudulent claims.
Speaking during a media briefing at the weekend, DoH Minister Dr Aaron Motsoaledi, said the probe was launched after a claimant demanded R70 million for a botched circumcision, however, it was found that the patient suffered a very serious genital infection and the hospital saved his life.
He said an overarching investigation by the Special Investigating Unit (SIU), in 2017 revealed that most of the cases were emanating from Gauteng and the Eastern Cape.
“By that time, the Eastern Cape contingent liability in respect of medico-legal claims amounted to R15.9 billion while in Gauteng the figure was R21.2bn," he said.
He said most of the claims were for cerebral palsy and most of the claims were made by legal practitioners or scouts masquerading as social workers, without the claimants' knowledge.
In the Eastern Cape, most of the claims were from Johannesburg-based law firm, Nonxuba Attorneys, who have since been charged in this regard.
Forty-four claims, to the tune of R497m, were lodged between 2012 and 2017.
“Between 2010 and 2016, medico-legal claims increased from 46 to 529 in the Mthatha High Court alone. There is evidence of collusion between attorneys, touts, nurses and doctors in both the public and private healthcare,” he said.
“In some instances nurses stole the medical records and illegally handed them over to attorneys.”
The minister noted that there was collusion between hospital staff, legal firms as well as employees in the Office of the State of Attorney where out-of-court settlements for hefty sums were entered into without the mandate or knowledge of the department.
“Litigating attorneys would even sue for one case in two different courts. A variation of that is a situation where two different lawyers would claim for the same patient using identical details,” Motsoaledi said.
“Notably, whereas the patient is one person, the two attorneys will claim for vastly different amounts. One attorney would claim R7.5 million and the other R25 million for the same patient and same condition. This clearly indicates the arbitrariness of the claims.”
The Chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, has welcomed the investigation.
He said the findings presented by the SIU reveal a disturbing pattern of fraudulent claims, unethical practices, and collusion among legal practitioners, healthcare professionals, and even some officials within the system.
"Such actions not only undermine the credibility of our healthcare services but also divert essential resources away from patient care," Dhlomo said.
IOL News