Pharmacists billing fridges and television sets to the medical-aid accounts of prison staff are among the types of fraud uncovered in the Department of Correctional Services in recent years.
”Some [pharmacists] started stocking even TVs and refrigerators,” special investigating unit (SIU) head Willie Hofmeyr told reporters in Pretoria on Monday. ”People would go buy refrigerators [at pharmacies].”
Hofmeyr said the department saved about R500-million in medical-aid claims in the 2004/05 financial year by clamping down on fraud and corruption.
Claims for the year had been expected to reach about R1-billion, but amounted to just more than R500-million.
That was about one-20th of the department’s R9,8-billion budget for the financial year — R5,5-billion of which was to be spent on salaries.
A total of 25 medical doctors and 244 departmental staff have been investigated for medical-aid fraud and corruption from 2002 to date, Hofmeyr said.
Ten medical practitioners and 28 departmental members face prosecution, of which one doctor and five members have been convicted.
A total of R585 105 has been recovered from nine officials thus far.
Correctional-services commissioner Linda Mti said the department has recovered more than R23-million in fraudulent medical-aid claims thus far and expects to reclaim another R80-million from about 16 doctors.
The department is providing R6-million a year to employ a full-time team of SIU fraud investigators.
Examples of fraud committed include a doctor charging between R5 000 and R30 000 for injections costing R124 each, another charging R200 000 to the medical-aid account of a member without a consultation, and another submitting false or excessive claims for consultations amounting to R7,6-million in one year.
‘Pyramid scheme’
Some doctors paid prison staff kickbacks for allowing them to submit false claims on their behalf. The practice later escalated into ”almost a kind of pyramid scheme” with members receiving commissions for getting colleagues on board, Hofmeyr said.
Also, some corrupt members sold innocent colleagues’ medical-aid details to doctors, who used these to put in false claims.
Mti referred to instances of members getting sunglasses through the medical aid, although this was not a permitted benefit, and having gold teeth put in.
The fact that members were previously not required to make any contribution to their medical-aid costs added hugely to the problem of corruption, he said.
But since January last year, members have to contribute one-third of their medical-aid cost.
Deputy commissioner Jenny Schreiner said efforts to promote whistle-blowing in the department have yielded 233 reports so far this year, and 270 last year.
In prison visits countrywide, the SIU has so far interviewed more than 100 000 inmates and 16 000 officials, resulting in about 10 000 investigations in the past year.
About 400 staff members face internal investigation, with 10 having been dismissed so far. Four have resigned and 95 have received warnings.
The unit has given 60% of prisons visited a clean bill of health concerning fraud and corruption, Schreiner said.
Apart from medical-aid fraud, other reported instances of wrongdoing include ”unlawful operations” in prison pharmacies and kitchens, and the irregular procurement of contracts for goods and services.
Mti said the department hopes to boost its staff numbers by 10 000 to 45 000 over the next three years.
He lamented the fact that many warders lack the skills required for their extraordinary responsibility — much of it brought on by prison overcrowding.
The highest qualification of many current staff is a matric certificate and the fact that they have no criminal record. Ongoing on-the-job training is, therefore, essential, he said. — Sapa