Doctors defraud fund of R38 mln

2013-02-12 00:00

THE Compensation Fund has lost R38 million in the past three years to fraud by doctors colluding with its staff.

In KwaZulu-Natal, an unspecified number of doctors are being investigated for fraud estimated at R3 million.

No arrests have been made.

The fund is a public entity of the Department of Labour, and its duty is to provide cover for the compensation of workers injured or who fall ill while working.

North West and Gauteng are said to be the provinces with the most cheats. Already the fraud across the country has led to 13 staff members of the fund being dismissed, with criminal charges filed against them.

A doctor in Northern Cape is on trial for fraud totalling R680 000.

Twana Makubela, the fund’s head of risk management, said they discovered the multi-million rand fraud when they hired forensic investigators to look into suspicious payments.

“We then sent teams into the field to investigate the claims and we discovered that the claims were hugely inflated and in some cases the doctors had never seen the patients.

“The staff collude with the doctors by giving them information about the patients and the doctor creates a fictitious invoice … those very same staff will then process that invoice and they will split the claim,” said Makubela.

“We discovered that in a single case a doctor had charged R300 000 for consultation, something that is not possible.”

Makubela said they also discovered that a doctor in one province would claim to have treated a patient in another province.

“We caught on to this because a patient has to file a travelling claim, but we were only receiving claims from doctors.”

He said that in KwaZulu-Natal, the challenge was mainly over prosthetics. “You find that a person has lost an arm or leg at work and we give him a prosthetic limb. A service provider will show up and tell that person, ‘I can give you a better prosthetic’.”

The patient will give the service provider his or her details, including the claim number. The service provider then uses those details to claim and runs off with the money, while the patient never receives the prosthetic.

Makubela said clients should follow the progress of their claims by phoning the call centre at

­0860 1056 350.

Join the conversation!

24.com encourages commentary submitted via MyNews24. Contributions of 200 words or more will be considered for publication.

We reserve editorial discretion to decide what will be published.
Read our comments policy for guidelines on contributions.

24.com publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
0 comments
Comments have been closed for this article.

Inside News24

 
/News

Book flights

Compare, Book, Fly

Traffic Alerts
There are new stories on the homepage. Click here to see them.
 
English
Afrikaans
isiZulu

Hello 

Create Profile

Creating your profile will enable you to submit photos and stories to get published on News24.


Please provide a username for your profile page:

This username must be unique, cannot be edited and will be used in the URL to your profile page across the entire 24.com network.

Settings

Location Settings

News24 allows you to edit the display of certain components based on a location. If you wish to personalise the page based on your preferences, please select a location for each component and click "Submit" in order for the changes to take affect.




Facebook Sign-In

Hi News addict,

Join the News24 Community to be involved in breaking the news.

Log in with Facebook to comment and personalise news, weather and listings.