Overcharging doctors get stiff penalty
Medical aid scheme takes on fraud and abuse
Gauteng doctors were this week found guilty by the Health Professions Council of South Africa (HPCSA) of charging for services not rendered and unprofessional conduct.
Benoni-based Dr Abdul Samid Carim appeared before the council on Tuesday. Carim, who has been practising for 42 years, pleaded guilty and was suspended for 12 months. The sentence was suspended for two years.
Dr Ronica Chittigadu of Carletonville, who has been practising medicine since 1997, also pleaded guilty on Friday. She received the same sentence.
The charges follow a clampdown by Discovery Health medical aid, which has estimated that the cost of fraud and abuse is between R3-billion and R15-billion annually, said general manager for forensic services Marius Smit.
Carim, a family physician working in a practice with other doctors, was found to have charged patients for treatments they did not receive. He said he had not personally treated the patients whose accounts were queried by Discovery Health, but as a senior partner in his practice, he took responsibility because he benefited from the patients’ payments. The loss to Discovery on these claims was less than R300.
“These charges have brought me nothing but sleepless nights and anxiety and have left me emotionally battered. I am in the twilight of my career, and all my life I have tried to instil the highest moral standards in my children, patients and community,” he said.
General practitioner Chittigadu struggled to hold back tears as she pleaded with the panel to “show mercy on her” when sentencing her because she financially supported her two children, her husband and her parents.
Two patients visited her surgery in Gateway, Carletonville, in January 2011 and were given generic medication, but were charged for branded drugs. The total loss to Discovery was R67.
“These charges have made me feel as if I have failed my family, the medical profession and myself. I am remorseful and have learnt a valuable lesson from this,” she said.
The pro-forma complainant in both cases, Viraj Ramdas (HPCSA prosecutor), said doctors charging for services not rendered was a plague in the country and the council needed to send a strong message to potential offenders so they stopped committing these crimes.
Smit said healthcare fraud was a global problem.
“The cost of medication forms a significant portion (17%) of Discovery Health medical scheme’s healthcare spend, totalling R6-billion. Fraud also occurs with pharmacies, clinics and hospitals.”
He said healthcare fraud affected everyone and resulted in increased healthcare costs and higher premiums, and reduced benefits as medical schemes looked at ways in which they could combat fraud more effectively.