Fraudsters conniving to fleece the Road Accident Fund

THE Road Accident Fund is being targeted by fraudsters who are said to be colluding with corrupt police officers and the organisation’s employees in order to get their hands on payouts.

Dishonest touts, doctors and lawyers go as far as fabricating claimants’ payslips and medical records or create fictitious dependants and customary marriages for the claimants in order to inflate cash payouts.

In some instances, daring claimants have provided specialist titles to try to deceive the RAF investigators to approve their inflated claims.

The RAF’s 2016/17 annual report, released last week, showed a significant rise in fraudulent claimed amounts made to the entity.

The number of rejected claims increased from 612 in the 2015/16 financial year to 643, resulting in R901 million in fraudulent claims being detected by its forensic investigation department (FID) before payouts were made.

At least 88 people were arrested and 68 convicted, compared to 136 arrests and 188 convictions in the previous financial year.

The dirt also extended to RAF employees, as 170 cases of fraud were investigated internally, of which 37 were for misconduct and fraud, which yielded 14 convictions, four resignations while investigations were under way, five suspensions and 11 cases where disciplinary action was instituted.

Some of these cases involved employees who were caught touting or selling claims that were initially reported to them by lawyers, which often resulted in inflated claims.

A total of 707 fraud cases were referred to the police.

The FID’s general manager, Paul Molefi Modipa, said fraudsters were getting smarter in trying to lay their hands on the RAF’s revenue of R33.3 billion.

The latest trends involved tow-truck drivers, private ambulance personnel and police officers, who are usually the first to arrive at an accident scene.

Modipa said that in one high-profile case, currently being heard in court in the Eastern Cape, a doctor colluded with a tout about an accident in 2007, involving two buses carrying 83 passengers.

“In our investigation we found that the two buses were going to collect people for a political event when they collided. And there were no passengers in either of them.

“But the doctor claimed he had treated all 83 passengers in his surgery that day. We couldn’t get proof of that, including the CCTV footage in his practice. We went to the Health Professions Council of SA, and they said it was impossible for one doctor to treat that many patients in one day,” Modipa said.

By law, a private ambulance service can claim from the RAF for transporting road accident victims to hospital. But Modipa said this system was now being abused, as companies would claim for inflated trips.

“We pay them per kilometre travelled and in many cases you’d find they would rather take patients to far-away hospitals, which have touts who sell cases to lawyers they know,” said Modipa.

Chris Hani Baragwanath Academic Hospital in Soweto has been red-flagged for touting after an outsider was recently caught stealing four medical records belonging to car accident patients, he said.

Funeral parlours are also targeting the RAF by claiming to have buried claimants, but when the families of the deceased are contacted, it is discovered that they used another funeral parlour.

By law, the RAF can only pay a standard R15 000 towards a deceased’s funeral costs.

In another incident, a bricklayer from Mpumalanga stated in his claim application that he was working as a “specialised bricklayer” for a company contracted to build a school, Modipa said.

But the RAF’s investigations showed that such occupation did not exist in the country and that the company never had such a tender with the government at the time.

The FID has also launched a cyber manager system to monitor trends in accident hotspots.