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Net closes in on doctors and lawyers who fleece state through fraud claims

2018-12-12 22:09

The days of unscrupulous lawyers and doctors who are defrauding the Gauteng health department of billions of rands every year are numbered.

City Press understands that their modus operandi is to create fictitious medical negligence cases, including personal injury, and then claim for millions from the government.

This plunder of the public purse is believed to be one of the reasons the Gauteng health department, which is often in the news for the wrong reasons, is facing financial problems.

Gauteng Premier David Makhura told City Press in an interview that he requested the Special Investigating Unit (SIU) to probe allegations of collusion between lawyers and doctors in a detailed scam to milk the troubled health department.

“The SIU is helping us deal with the health investigation. It is a big thing for Gauteng. We get huge bills – R2 billion or R3 billion claims. There is a lot of cookery. They are fleecing government money,” Makhura said.

He said fraudulent activities around medicolegal claims involve lawyers working with doctors to create cases of negligence where they don’t exist.

“The SIU briefed us that the same lawyers who are doing those claims in the Eastern Cape are the ones who are doing the claims here.”

Last year, the Hawks launched an investigation after suspicious medical negligence claims totalling millions of rands came to light in the Eastern Cape.

Although Gauteng DA shadow health MEC Jack Bloom agreed that some unscrupulous lawyers and doctors were defrauding the health department, he said there was an exaggeration of the issue to downplay “all the genuine malpractice cases because of a failing health system”.

Bloom said the fraud cases that occur are facilitated by poor record-keeping and collusion with unethical people in hospitals.

“The priority should be running a high-quality health service to minimise negligence claims and block the opportunities for fraudulent cases to be made.”

Bloom said the real reasons for the department’s financial problems are poor management and high levels of wasteful expenditure and corruption.

“The department paid out R521 million in medical negligence claims between January [last year] and March [this year], which were all proven in court,” he said.

Gauteng Health MEC Gwen Ramokgopa said investigations were at an advanced stage.

“We are working with the SIU and will release a preliminary report in due course. Our approach is to comprehensively deal with all risk factors, including collusion,” Ramokgopa said.

SIU spokesperson Nazreen Pandor said this week that the unit has seconded members to the department to assist with the investigation.

“The SIU is not yet in a position to provide the level of detail that is required. Where the investigation indicates or points to a fraudulent claim the secondment team will assist the department with reporting the matter to the SA Police Service.

“Should such claims be the subject of pending civil litigation against the department, the evidence will be brought to the attention of the department so that it may be used by the department in its defence of such claims,” Pandor said.

The revelations come as the department is still trying to recuperate from the Life Esidimeni tragedy, which led to the death of more than 100 mentally ill patients, as well as a deadly fire at its building in Johannesburg.

“I told all [heads of department] that I don’t want another case of Life Esidimeni, where officials said ‘my MEC forced me to do this’.

“I said to them: ‘You are accounting officers, you take responsibility. The law gives you the authority,’” Makhura said.

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January 26 2020