The medical industry is losing billions of rand a year due to fraudulent claims by doctors, dentists, pharmacists and optometrists, the Cape Times reported on Thursday.
Its website quoted health-care funders as saying fraud is costing the industry up to R12-billion a year.
In a clampdown on such activities, more than 2 000 cases are being investigated by the forensics management unit (FMU), a division of the Board of Healthcare Funders.
The chairperson of the board’s FMU, Marius Smit, said the board comprises 93% of medical schemes.
”Some of the investigations have emanated from anonymous tip-offs, while others have come from the reporting of fraudulent members or health-care practitioners.”
Smit said investigations sometimes include the use of hidden surveillance equipment to ensure evidence will be admissible in court.
Cases uncovered include:
- a Mthatha doctor charged with 1 493 counts of fraud and 1 745 counts of theft, amounting to R910 443, for allegedly selling, dispensing and being in possession of scheduled medicines;
- a KwaZulu-Natal doctor who is being investigated for colluding with a sales agent of an expensive brand of cooking pots — the doctor told patients the pots were ”health pots”, which would be paid for by the medical aid; and
- an optometrist in Cape Town who is being investigated for dispensing fashion sunglasses, and claiming prescription glasses from the medical-aid scheme.
The Health Professionals Council of South Africa said the average number of complaints against practitioners has risen to about 132 per month, up from 78 per month in 2001.
In the past financial year, 61 cases were referred to the police for further investigation, with more than R1,4-million in admission-of-guilt fines being paid. — Sapa