Dodgy medical claims: ‘Physically disabled’ but found cycling in a village

Despite rumblings that Cabinet has rejected the NHI Bill, the health department is adamant that "all is well". Picture: iStock
Despite rumblings that Cabinet has rejected the NHI Bill, the health department is adamant that "all is well". Picture: iStock

It’s R23 billion and counting – that is the amount in medico-legal claims the Eastern Cape faces, has racked up in the past 20 years.

Although some of the claims are genuine, the situation is exacerbated by many fraudulent claims from unscrupulous lawyers exploiting the provincial health department after the Road Accident Fund shut its taps.

In his state of the province address last week, Eastern Cape Premier Phumulo Masualle said the medico-legal claims were “one of our biggest concerns”.

The problem exists across the country.

Special Investigating Unit (SIU) spokesperson Nazreen Pandor said its investigation into dodgy medical claims included one into the State Attorney’s office across all nine provinces, which has so far revealed “irregularities”.

Many of these are being considered and will soon be referred for criminal and disciplinary action and, where necessary, civil action to recover the money.

The head of the State Attorney’s Office in Gauteng has been placed on precautionary leave pending disciplinary action, Pandor said.

“In Gauteng, in particular, SIU entered into a memorandum of understanding with the Gauteng provincial government to assist the investigation into corruption. The investigation in Gauteng has uncovered similar fraudulent medico-legal claims and criminal referrals have been made,” she said.

“Until the suspects have been charged and appeared in court, we cannot mention details. In this regard the SIU, NPA [National Prosecuting Authority] and Hawks are collaborating to ensure that criminal referrals are processed speedily so that the suspects can be arrested, charged, prosecuted and sentenced on conviction.”

Masualle’s spokesperson, Sizwe Kupelo, said last week the situation was “really testing the state in terms of finances”.

In 2017 the provincial health department appointed law firms Norton Rose Fulbright and Smith Tabata to investigate medico-legal claims and they managed to identify fraudulent and duplicated claims amounting to R70 million in six months.

Some cases recently uncovered are of patients defrauded by their lawyers who ran away with the money.

“We have cases in which lawyers have submitted claims, that some kids were harmed during birth, only to find that kid running in the villages,” Kupelo said.

“A team of investigators found one playing on a bicycle when it was claimed he was physically disabled. And the family was not even aware that a medico-legal claim had been made on the child’s behalf.”

Kupelo said health department officials had been nabbed by security companies trying to steal the medical records of patients for lawyers wanting to make fraudulent claims.

Patients, he said, were being canvassed and promised huge amounts of money. And sometimes up to four different lawyers would submit claims against one case, Kupelo said.

Most claims are maternity related and the department had selected 32 health facilities where more doctors and nurses were employed to beef up staff and prevent further claims.

Kupelo said he had met a woman who won a R10 million claim against the department but her lawyer gave her only R100 000 and pocketed the rest.

Eastern Cape health MEC Helen Sauls-August said there had been “tremendous progress” since private lawyers were appointed, with 45 cases being thrown out of court in six months.

“From 125 cases a month, we are now down to 25 cases a month, so that is a significant drop in the number of cases brought forward.”

Kupelo said by working with the SIU and the Hawks, prominent Eastern Cape lawyer Zuko Nonxuba was arrested in relation to medico-legal claims amounting to R30 million.

He was released on R80 000 bail at the Mthatha Magistrates’ Court and is expected to reappear on March 25.

Attorney Mvuzo Notyesi, president the National Association of Democratic Lawyers and co-chairperson of the Law Society of SA, said incidents of lawyers defrauding the state were isolated and the government should not shift the blame.

“The government is diverting the issue of failing to improve infrastructure and administration and failure to comply with the Constitution as it requires them to provide health services to the people.

“Now they rely on isolated cases where there might be some fictitious claims.

“Broadly, the claims that have been brought against the state were correct,” he said.


Fraudulent medico-legal claims are robbing the system. What should be done to stop these criminals?

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