The Hawks are investigating corruption in the medical aid industry and have already raided 12 premises, the Sunday Times reported.
Trustees of two medical aids, Hosmed and Commed, allegedly worked with officials from the Council for Medical Schemes, the industry regulator, to defraud medical aid members, the paper reported — citing an affidavit from police Lieutenant-Colonel Gezina Lottering.
Allegations against these medical aids first surfaced last year but apparently no action was taken against them.
Administrator Allcare — which looks after the medical aid accounts of 135 000 people — had also been implicated, the newspaper reported.
Lottering’s affidavit described a “culture of dishonesty” at Allcare including bribery, corruption and contraventions of the Medical Schemes Act.
She said money was systematically stolen from Commed through the submission of fictitious supplier invoices.
This required the appointment of compliant trustees who would allow these fake invoices to be submitted.
Coming clean
Commed and Allcare premises were raided by the Hawks as part of this investigation, according to the Sunday Times.
One particular case of corruption detailed by the Sunday Times involved an alleged bribe paid by Allcare to Commed’s former chairperson.
David Tsalapedi, a whistleblower fired by Allcare, said in an affidavit that Raato Mogajane had asked for a R50 000 bribe to ensure Commed retained Allcare as its medical aid administrator — a contract worth R30-million a year — despite it being cheaper to switch administrators.
Tselapedi struck a deal with prosecutors this month to come clean in exchange for a 12 year suspended sentence.
Tselapedi said that earlier this year, he, Allcare’s human resources boss Mzingendoda Xulu and Commed principal officer Thabisile Mfaba, drove from Johannesburg to Zeerust to meet Mogajane to pay the bribe.
“In return for the payment, Mogajane undertook to influence the operation and extension of [Allcare’s] contract [with] Commed,” he was quoted as saying.
Sack of money
Tselapedi told the Sunday Times how Mogajane met the “bribe delegation” at a former Spur site in Zeerust. “He was drinking Johnny Walker Black Label whisky [and] was handed a white sack with R100 notes.”
Mogajane denied taking the bribe, suggesting that Tsalapedi was suffering from sour grapes after his dismissal from Allcare.
The Sunday Times said Mfaba and Xulu denied taking part in bribing Mogajane, saying Tselapedi was being “vindictive” because she was involved in getting him fired.
Allcare CEO Howard Phillips told the weekly that “absolutely nothing improper” happened at his company and that Tsalapedi was fired because he was dishonest.
Philips said while Tselapedi admitted to cooking invoices, he did this with Commed’s former principal officer, Langa Mconi — without Allcare’s knowledge. “After an in-depth investigation into fraud … Commed laid charges with the police last year against [Mconi] and the trustees but nothing happened,” he was reported as saying.
Philips said the raids look suspiciously timed to ensure that Allcare lost the lucrative R30-million administration contract with Hosmed to rival Thebe. — Sapa, the Sunday Times