The assistant director of the Health Department lab allegedly milked medical schemes of nearly R2-million
Nawaal Deane
A senior national Health Department official, Joel Mokonoto, appeared in court this month on charges of fraudulently milking the state’s medical aid scheme of R1,9-million.
The assistant director at the tuberculosis (TB) laboratory in the Health Department is alleged to have set up a fictitious laboratory and submit claims to Medscheme for people who had not been his patients.
Mokonoto’s case is one of several charges of alleged fraud in the Northern Province being probed by Medscheme. According to Medscheme director Gary Taylor, the
suspected fraud totals about R10-million.
The health department has not suspended Mokonoto. The medical technologist in charge of the government’s TB laboratory has been an employee at the department since 1982.
“The department is aware that I am being investigated but there are no grounds for them to take action until the case is heard in court,” says Mokonoto. A representative says the Health Department prefers not to comment “until the case has been concluded and the verdict given”.
According to the police investigation, Mokonoto used a fictitious address in the Northern Province to set up his non-existent laboratory. Mokonoto’s Medscheme claims used five different addresses, mainly Shop 10 at the Why Not shopping centre in Thohoyandou. Police investigators found it was non-existent.
Mokonoto allegedly pulled off his scam by obtaining the records of Medscheme members, and then making fraudulent claims in their names. Doctors named on the claims have denied sending any patients to Mokonoto.
Experts at the National Pathology Consulting Group say the types of tests on the claims by Mokonoto were “unusual” and in some instances “highly unlikely”.
“Mokonoto’s patients would have had to be in hospital for those tests to be administered,” says Roger McCallum, executive director of the group. McCallum says Mokonoto’s accounts had “unusual” and some “bizarre” patterns. The high costs of the tests on the claims to Medscheme and their sophistication were not normal.
The average amount claimed for each of Mokonoto’s tests during a two- year period ranged between R1 000 and R2 000. According to McCallum, in one instance irregular claims were submitted for two family members on the same Medscheme membership number for identical, rare tests in a two-week period. “This is a very unusual occurrence, almost like lightning striking twice at the same place,” he says.
One of the investigators working on the case said experts he had consulted believed some of the patients had they really existed should have been close to death from loss of blood because of the number and types of tests listed.
Mokonoto’s qualifications have also come under the spotlight during the police investigation. Jako Schoeman, former chair of the private practice of Society of Medical Laboratory Technologists of South Africa consulted during the probe, says: “In our analyses of the claims we discovered that Mokonoto was doing biochemistry and haematology tests when he was only qualified in microbiology and serology testing.”
Helmuth Rode, registrar of the Health Professions Council, says: “Mr Mokonoto is not entitled to practise in independent practice, category microbology and immunology, without supervision.”
Medscheme paid claims worth R974 000 to Mokonoto before getting suspicious. Before being investigated, he had submitted claims worth R1,9-million.
Mokonoto was arrested in April last year and appeared in court on February 5 when the case was remanded until April 18.
Arno Rossouw, advocate from the National Directorate of Public Prosecutions, expects more arrests in connection with the scam.