Dispute over R7m medical aid payout

A RETIRED Mthatha surgeon and former Walter Sisulu University medical school dean, Professor Lizo Mazwai, is fighting tooth and nail against returning a lump sum of more than R7-million a medical aid mistakenly deposited into his account.

According to court papers, Mazwai’s account administrators, Medical EDI Services – which assists doctors to submit claims to medical aids – filled in an incorrect amount in what was termed the software’s “multiplier column”.

So instead of claiming for one operation at a cost of R2 800, it had claimed for 2 469 at that price. The result was a hefty bill of more than R7-million being submitted to Metropolitan Health, which administers claims on behalf of the Government Employees Medical Scheme (Gems).

Metropolitan Health had approved the payment and Gems had duly paid Mazwai.

Mazwai said in an affidavit he thought the money was a pension payout.

Metropolitan Health’s lawyer, Advocate Chris Eloff SC, said the case was a simple one where a doctor had received R7-million he was not entitled to.

He had spent some and then “belatedly” put R2.5-million into his attorney’s trust account.

“Why do that if you honestly believe the money is yours?” he asked.

Mazwai’s lawyer, Advocate Dali Mpofu SC, said even if Mazwai had not placed in dispute that he was overpaid to the tune of R7-million, there was the question of who should be paid back.

He also questioned if the original amount of R7-million had to be paid back at all if Mazwai had honestly spent the money believing it was a pension payout.

Acting Judge Nicola Redpath-Molony will deliver judgment on Tuesday.