DR. LUKOJI HAS NO CONTRACTUAL RELATIONSHIP WITH SWAZI MED
SMART Clinic’s Dr. Tshibungu Jean Lukoji who was suspended from direct payment by Swazi Med has argued that he was not given a fair hearing before he was suspended.
In his urgent application, to have his suspension lifted, he argued that he was not given a fair hearing since he was only called for a meeting and later served with the letter of suspension.
Making his submissions through his Lawyer Thulani Sibandze yesterday, he said he had expected to be given time to call his witnesses and seek legal representation arguing that the respondent (Swazi Med) did not follow the legal process for a hearing before sanctioning the suspension.
He felt that the hearing was supposed to be in a form of a disciplinary one where the accused person is given a chance to call his witnesses and seek legal representation.
However, before the matter could proceed any further, High Court Judge Sipho Nkosi wondered how Dr. Lukoji expected such to happen since he had no contractual relationship with the respondent but only provided services to the respondents’ members.
Judge Nkosi said Swazi Med only had relations with its members, who only consulted doctors of their own choice who in turn provided services to them before a claim from the members’ funds could be filed and processed.
Sibandze explained that Dr. Lukoji submitted academic credentials to Swazi Med and such was viewed as a contract, however, the court dismissed this.
Judge Nkosi said such would only be done for purposes of confirming that a doctor was indeed qualified to provide services for its members and that he or she was registered wit the Medical and Dental Council in the country.
Swazi Med in the Principal Officer Peter Simelane’s affidavit, submitted that the medical aid fund does not in any way have any contractual relationship with Dr. Lukoji, hence they invited him to the meeting as a service provider to its members where the alleged fraudulent claims were explained to him before his suspension.
Judge Nkosi advised that the matter be postponed to next Wednesday in order to allow both counsels to file supplementary affidavits since the issue of a medical aid scheme regulator also came up before the arguments were taken any further.
Representing Swazi Med in the matter was Senior Lawyer Mangaliso Magagula from Magagula/ Hlophe Attorneys who submitted that during the meeting that was held between the Swaziland Medical Aid Scheme and Dr. Lukoji on March 8, he admitted to have fraudulently submitted these claims.
He submitted that Dr. Lukoji admitted to having submitted the claims fraudulently and stated that he did not know because his billing was done by his clerk and he did not check the claims which were submitted.
This is confirmed in an answering affidavit filed by Simelane to the effect that “He apologised and offered to pay back the money and also admitted that there were irregularities in his claims, his claim that he was not given proper time for the hearing is incorrect.”
He quoted Dr. Lukoji in his affidavit filed in his application as having stated that “as soon as I was made aware on the abnormalities and requested to attend a meeting to discuss same, I duly represented myself and confirm that I was willing to refund any claims overcharged by my practice and apologize profusely for the occurrence,” Simelane quoted.
Simelane stated that Swazi Med was compelled to suspend Dr. Lukoji for defrauding the scheme for such vast sums of money and that it was clear that he is only interested in himself not his patients whom he is alleged to have cheated by defrauding them and the scheme. In his application Dr. Lukoji submitted that he now fears that his private practice might be shut down following his suspension and his children who are in university might drop out due to financial constrains following his suspension.
The Manzini based doctor has run to court challenging his suspension as a direct payee and seeks an order of court to have the suspension lifted and set aside.
The matter has been postponed to next Wednesday for full-blown arguments between the two parties.
WONDERED: High Court Judge Sipho Nkosi.