Doctor guilty of medical aid fraud

2013-09-13 00:00

A DURBAN doctor was found guilty of medical aid fraud for submitting an inflated claim to Discovery Health at a Health Professions Council (HPCSA) of SA hearing this week.

HPCSA spokesperson Bertha Peters-Scheepers said Dr Roshen Koovarjee had been found guilty after submitting a claim to the scheme for brand name drugs when he had dispensed generics.

He was fined R20 000 and wholly suspended for two years on condition he is not found guilty of a similar offence during the period.

“Discovery was prejudiced for R77,35,” Peters-Scheepers said, adding they were concerned about the increase in accounts-related complaints lodged with the council.

The HPCSA received a total of 2 997 complaints between April 1, 2012, and March 31, 2013. Some 253 complaints related to fees and accounts, and most of these related to specialists.

“Of these, 403 were referred to the office of the ombudsman and 117 were opened as police files [as these were] unregistered people practising as healthcare practitioners,” Peters-Scheepers said.

The HPCSA’s preliminary committees of inquiry considered 1 827 matters and 734 cases were finalised, with 201 findings of guilt, while 199 cases were referred to the professional conduct committee.

“The HPCSA would like to urge the public to be aware upfront of what the cost of treatment is and to scrutinise their statements,” adding that the Medical and Dental Professions Board within the council was currently busy determining a guideline tariff.

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