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KZN health professionals to pay millions following fraudulent claims

Yet another group of health care professionals from the KwaZulu-Natal Health Department are to repay millions of rands after they were found to have fraudulently made over R151 million in claims from medical aid schemes.

The department says an investigation has revealed that 407 health care professionals made claims through various medical aid schemes while in the employment of the department.

This comes as the department is in the process of recovering money from individuals found to have been illegally doing business with the provincial government to the value of R82 million. 

According to Section 30 of the Public Service Act, employees in the public sector are not allowed to perform remunerative work outside public practice, except with written permission from the MEC.

Head of Department, Dr Sibongile Zungu, says they have been facing challenges with medico legal cases, patients waiting long for services and unsupervised junior staff. 

This then prompted a probe which found that some full time employees had private practices and were seeing patients when they should be in public hospitals. 

Dr Zungu says they also treated their patients in state hospitals and claimed from medical aids.

"In some instances, they would bring their private patients into the state hospital, prioritise them, treat them and claim from the patient either in cash or medical aid."

Those who've made these claims include doctors, specialists, psychologists, dentists and social workers. 

Dr Zungu says they have received cooperation from some of the medical aid schemes.

"At this point, three medical aids are coming forward and working with us fully on the matter and what we are doing is recoveries of the monies that were earned during the time that we had paid for. If you are a full time employee, you are paid for by the state. So any earning that you get during that time you are getting those earnings on state times and therefore you have to repay the state."

Of the more than R151 million claimed, the department says only R15 million is recoverable. Disciplinary processes have started against the 407 implicated individuals.

However, five have resigned and police are investigating four criminal cases relating to defrauding medical aid schemes. 

Dr Zungu says they have evidence against those implicated.

"Some of the health professionals are cooperating and they have signed debit orders, some have opted to pay lump sums and others are disputing. But when we bring forward the evidence, then they have to do the payments."

An internal audit found that 157 of them have been doing this since 2012.

Most of the work was done with the Education Department to the value of more than R23 million, followed by Transport with over R22 million and Social Development with more than R13 million.

Source:
http://www.sabc.co.za/news/a/3b7dbb8046854c7db6deffa1ce74a095/KZN-health-professionals-to-pay-millions-following-fraudulent-claims-20141211