NET CLOSES IN ON DOC­TORS AND LAWYERS WHO FLEECE STATE THROUGH FRAUD CLAIMS

CityPress - - News - NG­WAKO MODJADJI ng­[email protected]­press.co.za

The days of un­scrupu­lous lawyers and doc­tors who are de­fraud­ing the Gaut­eng health depart­ment of bil­lions of rands ev­ery year are num­bered.

City Press un­der­stands that their modus operandi is to cre­ate fic­ti­tious med­i­cal negligence cases, in­clud­ing per­sonal in­jury, and then claim for mil­lions from the gov­ern­ment.

This plun­der of the pub­lic purse is be­lieved to be one of the rea­sons the Gaut­eng health depart­ment, which is of­ten in the news for the wrong rea­sons, is fac­ing fi­nan­cial prob­lems.

Gaut­eng Pre­mier David Makhura told City Press in an in­ter­view that he re­quested the Spe­cial In­ves­ti­gat­ing Unit (SIU) to probe al­le­ga­tions of col­lu­sion be­tween lawyers and doc­tors in a de­tailed scam to milk the trou­bled health depart­ment.

“The SIU is help­ing us deal with the health in­ves­ti­ga­tion. It is a big thing for Gaut­eng. We get huge bills – R2 bil­lion or R3 bil­lion claims. There is a lot of cook­ery. They are fleec­ing gov­ern­ment money,” Makhura said.

He said fraud­u­lent ac­tiv­i­ties around medi­cole­gal claims in­volve lawyers work­ing with doc­tors to cre­ate cases of negligence where they don’t ex­ist.

“The SIU briefed us that the same lawyers who are do­ing those claims in the Eastern Cape are the ones who are do­ing the claims here.”

Last year, the Hawks launched an in­ves­ti­ga­tion af­ter sus­pi­cious med­i­cal negligence claims to­talling mil­lions of rands came to light in the Eastern Cape.

Al­though Gaut­eng DA shadow health MEC Jack Bloom agreed that some un­scrupu­lous lawyers and doc­tors were de­fraud­ing the health depart­ment, he said there was an ex­ag­ger­a­tion of the is­sue to down­play “all the gen­uine mal­prac­tice cases be­cause of a fail­ing health sys­tem”.

Bloom said the fraud cases that oc­cur are facilitated by poor record-keep­ing and col­lu­sion with un­eth­i­cal peo­ple in hos­pi­tals.

“The pri­or­ity should be run­ning a high-qual­ity health ser­vice to min­imise negligence claims and block the op­por­tu­ni­ties for fraud­u­lent cases to be made.”

Bloom said the real rea­sons for the depart­ment’s fi­nan­cial prob­lems are poor man­age­ment and high lev­els of waste­ful ex­pen­di­ture and cor­rup­tion.

“The depart­ment paid out

R521 mil­lion in med­i­cal negligence claims be­tween Jan­uary [last year] and March [this year], which were all proven in court,” he said.

Gaut­eng Health MEC Gwen Ramok­gopa said in­ves­ti­ga­tions were at an ad­vanced stage.

“We are work­ing with the SIU and will re­lease a pre­lim­i­nary re­port in due course. Our ap­proach is to com­pre­hen­sively deal with all risk fac­tors, in­clud­ing col­lu­sion,” Ramok­gopa said.

SIU spokesper­son Nazreen Pan­dor said this week that the unit has sec­onded members to the depart­ment to as­sist with the in­ves­ti­ga­tion.

“The SIU is not yet in a po­si­tion to pro­vide the level of de­tail that is re­quired. Where the in­ves­ti­ga­tion in­di­cates or points to a fraud­u­lent claim the sec­ond­ment team will as­sist the depart­ment with re­port­ing the mat­ter to the SA Po­lice Ser­vice.

“Should such claims be the sub­ject of pend­ing civil lit­i­ga­tion against the depart­ment, the ev­i­dence will be brought to the at­ten­tion of the depart­ment so that it may be used by the depart­ment in its de­fence of such claims,” Pan­dor said.

The rev­e­la­tions come as the depart­ment is still try­ing to re­cu­per­ate from the Life Esidi­meni tragedy, which led to the death of more than 100 men­tally ill pa­tients, as well as a deadly fire at its build­ing in Jo­han­nes­burg.

“I told all [heads of depart­ment] that I don’t want an­other case of Life Esidi­meni, where of­fi­cials said ‘my MEC forced me to do this’.

“I said to them: ‘You are ac­count­ing of­fi­cers, you take re­spon­si­bil­ity. The law gives you the au­thor­ity,’” Makhura said.

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