Phar­ma­cist takes on med­i­cal aid gi­ant

Dur­ban chemist lays crim­i­nal charge

The Sunday Independent - - FRONT PAGE - NABEELAH SHAIKH nabeelah.shaikh@inl.co.za

ADURBAN phar­ma­cist has laid charges of in­tim­i­da­tion and ex­tor­tion against the coun­try’s big­gest med­i­cal aid scheme Dis­cov­ery Health.

Pre­visha Har­riper­shad claims that Dis­cov­ery of­fi­cials tried to ex­tort over R1 mil­lion from her in 2013 by falsely ac­cus­ing her of mak­ing fraud­u­lent claims from the med­i­cal aid.

This week, Har­riper­shad de­cided it was time to pur­sue crim­i­nal ac­tion.

She said she was also in the process of open­ing a case with the public pro­tec­tor.

Har­riper­shad, who pre­vi­ously owned three phar­ma­cies in Dur­ban but now only has one, said the med­i­cal aid had crip­pled her busi­ness by ac­cus­ing her of a crime she did not com­mit.

She claimed that Dis­cov­ery foren­sic of­fi­cials co­erced her into at­tend­ing a “rou­tine” meet­ing in 2013 about a med­i­cal aid claim she made.

Har­riper­shad was preg­nant at the time and the of­fi­cials as­sured her the meet­ing was “noth­ing se­ri­ous”.

Har­riper­shad wanted her at­tor­ney to be present and asked for a resched­uled meet­ing, but the offi- cials ap­par­ently said it was not nec­es­sary.

“When I went to their of­fices in Joburg with my hus­band Ravesh, they took us to a se­cured room. Af­ter hav­ing a gen­eral dis­cus­sion, they placed a piece of pa­per on the ta­ble and said I was ac­cused of fraud re­lated to an ir­reg­u­lar trans­ac­tion,” claimed Har­riper­shad.

She said she was baf­fled and could not re­call the trans­ac­tion they re­ferred to. The trans­ac­tion amount was just over R1 600.

She was al­legedly told that two Dis­cov­ery of­fi­cials with spy cam­eras had vis­ited her phar­macy and recorded the fraud­u­lent trans­ac­tion in ques­tion.

“I asked if I could call the phar­macy to ver­ify the claims as I was on ma­ter­nity leave at the time, but they re­fused.

“The of­fi­cials then took out an ac­knowl­edge­ment of debt agree­ment for R1m and said we had to sign it if we didn’t want ac­tion taken against us.

“We asked if we could con­sult with our at­tor­ney first be­cause we were shocked at the R1m fig­ure, but one of the of­fi­cials be­gan rais­ing his voice,” said Har­riper­shad.

She al­leged the of­fi­cials then locked her in the room and said she had 15 min­utes to sign the form, or they would call the po­lice and have her ar­rested.

Har­riper­shad said she was un­der duress when she signed the ac­knowl­edge­ment of debt, but as soon as she was able to speak to her at­tor­ney, she placed a stop or­der on the pay­ments.

She said she had been fight­ing the scheme over its al­leged un­law­ful ac­tion in court since then.

Har­riper­shad said she had since lost two of her phar­ma­cies as a re­sult of Dis­cov­ery Health’s “dark cloud”, a crime she be­lieved she did not com­mit, hang­ing over her head.

The med­i­cal aid scheme stopped all claim pay­ments to her phar­ma­cies, she said.

“I’ve now ap­proached the po­lice af­ter be­ing ad­vised by var­i­ous peo­ple to do so.”

Dis­cov­ery Health chief ex­ec­u­tive of­fi­cer Jonathan Broomberg said the med­i­cal aid had sub­stan­tial ev­i­dence that the phar­macy had sup­plied mem­bers with non-claimable items, such as baby for­mula, nap­pies, cos­met­ics and shoes, and then sub­mit­ted claims for “pre­scrip­tion medicines”.

“There was also com­pelling ev­i­dence of in­stances where medicines were sup­plied to non-mem­bers and then claimed on a le­git­i­mate mem­ber’s mem­ber­ship.”

Broomberg de­nied that Dis­cov­ery of­fi­cials in­tim­i­dated Har­riper­shad and said there was no truth to the al­le­ga­tions.

“Dis­cov­ery Health’s ap­proach to in­ves­ti­gat­ing and deal­ing with fraud ad­heres to the very strictest stan­dards, and meets the re­quire­ments of the Med­i­cal Schemes Act, and broader prin­ci­ples of le­gal­ity,” Broomberg said.

“We have over the years in­vested con­sid­er­able time, en­ergy and re­sources to en­sure that this is the case, and the prin­ci­ples ap­plied have been tested and ap­proved in prior lit­i­ga­tion and this case was no dif­fer­ent,” he said.

A for­mal com­plaint had been lodged against Har­riper­shad with the South African Phar­macy Coun­cil, he said.

Po­lice spokes­woman Bri­gadier Mathapelo Peters con­firmed that Har­riper­shad’s case had been reg­is­tered at the Sand­ton po­lice sta­tion.

It would be al­lo­cated to a de­tec­tive for fur­ther in­ves­ti­ga­tion, Peters said.

PIC­TURE: SIPHIWE SIBEKO/REUTERS

A Dur­ban phar­ma­cist claims she has been framed by the coun­try’s big­gest med­i­cal aid.

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