The Health Sector Anti-Corruption Forum (HSACF) has addressed growing concerns about the rise in fraudulent medico-legal claims and organised crime within the health sector.
The forum emphasised the need for a united front against corruption in healthcare.
Bringing together a collaborative effort involving civil society, the private sector (including medical schemes and professionals), and the public sector (law enforcement agencies, regulators, and public medical schemes), the HSACF advocated for a comprehensive “whole-of-society” approach. The forum is on a mission to combat maladministration, malpractice, fraud, and corruption.
A major concern raised by the HSACF was the alarming increase in fraudulent medico-legal claims.
The Special Investigating Unit (SIU) recently briefed the HSACF on medico-legal investigations across several provinces, pointing out instances of ghost medical billing and potential fraudulent claims. The SIU is now actively involved in pursuing these cases to ensure accountability.
In the Eastern Cape, approximately 158 medico-legal matters to the value of about R2.9 billion for contingent liability have been identified and handled.
The SIU found there were no hospital records for all these claimants found at any of the hospitals. This represents ghost medical billing.
Through the SIU’s interventions, it saved the department R132.8 million.
Five medico-legal claims were identified, with judgments handed down in favour of the claimants, costing the department approximately R97.3 million, which was deposited into the trust account of the claimant’s attorney.
The SIU found the attorney failed to register trusts, communicate the outcome of High Court civil proceedings to the claimants, and withhold payments. The attorney was suspended by the Legal Practice Council (LPC) on unrelated matters, and the law firm’s trust account was placed under curatorship. The SIU is now preparing a referral to the relevant prosecuting authority and LPC.
In Gauteng, approximately 148 medico-legal negligence claims were being investigated by the SIU, amounting to R1.2 billion.
One potential fraudulent claim to the value of R55 million has been identified by the SIU, which has since advised the Office of the State Attorney to defend the matter.
Approximately 43 contingency liability cases to the value of R108 million have been identified as potential savings to the State. The cases would be removed from the departments’ contingency liability register.
In KwaZulu-Natal, four medico-legal claims were struck out following the SIU’s investigation, which led to the potential loss prevention of R109,553,250.
Two applicants withdrew their claims, while the other two were successfully opposed. Through the SIU’s intervention, a medico-legal claim payment of R1,498,050.06 was blocked.
The SIU investigation had revealed that the child, whose claim had been instituted, had passed away. The SIU investigation into 11 matters in the contingency liability register revealed that the claimants were found to be deceased.
As a result, the matters were removed from the contingency liability register by the health department. This resulted in a potential loss of approximately R124,303,250.
In the Northern Cape, approximately 140 medico-legal cases were identified. A total of 42 cases were being handled by three law firms.
During 2018, the SIU reported being approached by the Western Cape Department of Health regarding alleged fraudulent medical negligence claims submitted by Nonxuba Incorporated Attorneys on behalf of various claimants.
About 33 fraudulent birth injury claims were identified in the contingency liability register to the value of approximately R409 million. The Department reported the matter to the Law Society, and in April last year, the Western Cape High Court granted the LPC an order interdicting Zuko Nonxuba from continuing to practice as an attorney, pending an application by the LPC and Western Cape Health MEC to have the attorney struck from the roll of legal practitioners.
The Chairperson of the HSACF, advocate Andy Mothibi, commended the dedication of HSACF members to combat corruption and malpractice in both private and public healthcare. The HSACF also pledged support for the Law Society’s initiative to have fraudulent practitioners removed from the legal roll.
