Swazi Observer - - NATIONAL NEWS - By Sandile Nkam­bule

FOL­LOW­ING an ur­gent ap­pli­ca­tion filed by Manzini based pri­vate med­i­cal prac­ti­tioner Dr Tshi­bungu Jean Lukoji against his sus­pen­sion as di­rect payee at Swazi Med, the lat­ter in­sists that the doc­tor is still sus­pended.

Last week, High Court Judge Sipho Nkosi ad­vised both par­ties to have a meet­ing where they would dis­cuss a pro­posal of­fered by Swazi Med.

The Med­i­cal Aid Scheme had pro­posed that Dr Lukoji could pro­vide ser­vice to its mem­bers, but pay­ment could not be made to him di­rectly, in­stead the mem­bers would in turn file claims for same.

How­ever, when both par­ties ap­peared in court on Wed­nes­day, it tran­spired that they had not reached a con­sen­sus as Swazi Med, through its lawyers se­nior at­tor­ney Man­gal­iso Ma­gag­ula and Nol­wazi Kunene from Ma­gag­ula/ Hlophe At­tor­neys, in­sisted that the doc­tor re­mained sus­pended.

They sub­mit­ted that there has been a long stand­ing rule within the scheme which is used in work­ing with ser­vice providers and such en­tails its mem­bers be­ing treated by doc­tors of their own choice and later lodge claims with the scheme per­son­ally as mem­bers.

They stated that Swazi Med bent back­wards for mem­bers and owed its ex­is­tence to them since it was not a profit driven scheme, and even when it makes prof­its, same are ploughed back to the fund and could not act con­trary to the in­ter­est of its mem­bers.

They sub­mit­ted that Swazi Med took the de­ci­sion to sus­pend Dr Lukoji to pro­tect its mem­bers and the scheme, and has no in­ten­tion what­so­ever to cause harm as in­di­cated that the rules al­low that mem­bers could make a di­rect claim without hav­ing to pay cash.

In any event, ac­cord­ing to Swazi Med, a ser­vice provider was not paid cash when ren­der­ing ser­vice to Swazi Med mem­bers but sub­mits a bill payable at the end of the month.

They ar­gued that it is in the best in­ter­est of the mem­bers of the scheme to have their monies pro­tected and as man­agers of the scheme, Swazi Med could not al­low a sit­u­a­tion where the al­leged fraud­u­lent claims oc­cur.

See­ing that both par­ties were not in agree­ment, Judge Nkosi al­lowed them to again meet out­side Court D and find a last­ing so­lu­tion that would be in the in­ter­est of both the mem­bers and the doc­tor.

How­ever, when they re­turned to court, lawyer Ma­gag­ula sub­mit­ted that Dr Lukoji re­mained sus­pended.

He said from what they dis­cussed with the other party, it was ev­i­dent that Dr Lukoji still wants to be a di­rect payee, a thing which Swazi Med could not al­low.

Lawyer Jose Ro­drigues for Dr Lukoji then sub­mit­ted that they were not in agree­ment with Swazi Med and ap­plied that the mat­ter be post­poned to a later date for full-blown ar­gu­ments in the ap­pli­ca­tion filed by Dr Lukoji.

Dr Lukoji had sub­mit­ted that he now fears that his pri­vate prac­tice might shut down fol­low­ing his sus­pen­sion. This, he said, might re­sult to his chil­dren who are in univer­sity be­ing forced to drop out due to fi­nan­cial con­strains, fol­low­ing his con­tin­ued sus­pen­sion.

Swazi Med has pro­posed that same should ap­ply with Dr Lukoji and its mem­bers as there is noth­ing pre­vent­ing him from pro­vid­ing ser­vice to its mem­bers, save for the fact that he would no longer be a di­rect payee as it was the case be­fore. The pre­vi­ous sta­tus quo would al­low Dr Lukoji to pro­vide ser­vice to Swazi Med’s mem­bers and di­rectly file claims in re­spect of the treat­ment ad­min­is­tered.

SUS­PENDED: Dr Tshi­bungu Jean Lukoji.

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