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.

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