Medical fraud costs the country's economy
Discussions and debate are focused on state capture and its effect on the economy, but there’s another beast eating away at productivity, hurting the economy and undermining our health system. South Africa is open for medical fraud business.
Medical fraud manifests in two ways: bogus doctors in practice and bogus medical certificates issued to rob employers by keeping an employee away from work while earning a salary.
The phenomenon of suspiciously qualified or unqualified doctors opening practices in some townships and attracting unsuspecting patients has become a concerning norm. Just recently a bogus doctor was caught and arrested at his Mpumalanga surgery in front of patients, some of whom he had prescribed highly regulated schedule 4+ drugs.
These bogus doctors - and even dentists and specialists - are found not only in township surgeries but also in hospitals.
Although one may argue that the responsibility rests with the patient to ensure that they visit qualified doctors, it is difficult to check the credentials of the doctor before a consultation.
Up to now, what our medical field seem to lack is a robust, impenetrable system to vet medical professionals before employing or certifying them as good to practice.
Issuing a medical certificate to keep an employee away from work without need is fraud and both the doctor and the patient need to be held accountable. Albeit with very little remedial action taken, fraudulent medical certificates have been a problem for years.
Worse still, if you are sick of work or have a hangover, you can buy an authentic medical certificate on a street corner.
At a tavern in the North West, you can buy a drink and a sick note at the same time. Depending on how long you wish to stay away from work, it will cost anything between R60 to R200 without even visiting the doctor’s rooms.
The economy loses R55.2-billion annually to sick leave, according to an article in the Mail & Guardian in September 2013 quoting Adcorp Holdings’ employment index of that year.
I have since come across an IT solution aimed at combating the issuing of fraudulent medical certificates. This was designed and developed by young entrepreneurs from QwaQwa in the Free State.
What the system does is to allow only a qualified doctor - verified by the Health Professions Council of South Africa as good to practice - to issue a medical certificate with limitations to changing the date of the consultation and the number of days the doctor recommends for the employee to be off duty. The employer will receive the medical certificate from the doctor’s rooms on the day and at the time the employee had a consultation.
The system ensures that:
- Only registered practitioners and those authorised to issue medical certificates do so
- The date and time of issue (and examination) is not manipulated
- The medical certificate is only issued in the presence of the patient
- Bogus doctors don’t have access to the system.
This will help combating medical aid fraud through doctor registration verification and an electronic and paperless prescription system.