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Vigilant member fights back against fraud


In December 2007, Lebo Montshiwa* noticed that a number of items that had never been dispensed to her by her local pharmacy had somehow found their way on to her GEMS claims statement. Lebo immediately contacted Lerato Segopo*, the owner of the local Pharmacy, to find out what happened. Segopo told Lebo that it was standard practice.

As a concerned and proactive GEMS member, Lebo immediately lodged a complaint using the GEMS fraud line. It was at that very moment that the wheels of justice were set into motion. An extensive investigation followed revealing that Lebo's local pharmacy had submitted as many as 114 fraudulent medicine claims amounting to tens of thousands of Rands to GEMS during December 2007 and February 2009.

In 2013 Segopo was sentenced to four years imprisonment, suspended for three years. She was also fined R20 000.

It is because Mrs Montshiwa was not willing to look the other way and because she was willing to give testimony when it was needed, that the Scheme was able to pursue the case against the pharmacy to the end. She is an asset to GEMS!

If you know of any fraud taking place, protect your benefits by calling our anonymous 24-hour toll-free GEMS fraud line on 0800 21 22 02.

*Not her real name

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