The Eastern Cape Health Department has called for the prosecution of those implicated in the Special Investigating Unit’s (SIU) probe into fraudulent medico-legal claims.
This comes after a probe into the scandal revealed widespread abuse of government funds, with claims in excess of R15 billion.
On Saturday, Minister of Health Dr Aaron Motsoaledi revealed that an investigation by the SIU found that over five years, a single law firm submitted 44 suspected fraudulent medico-legal claims to the tune of R497 million against the Eastern Cape Department of Health.
The minister further stated that an SIU investigation into alleged fraudulent medico-legal claims has saved the national Department of Health more than R3 billion.
He singled out a known legal practitioner by the name of Nozuko Nonxuba, of the Johannesburg-based Nonxuba Attorneys Inc, as one of the biggest culprits, saying he has over five years submitted 44 suspected fraudulent medico-legal claims to the tune of R497m against the Eastern Cape Department of Health.
On Monday, the Eastern Cape Department of Health head Dr Rolene Wagner, speaking to Newzroom Afrika, said those implicated in the corrupt practice of submitting fraudulent claims against the department must be prosecuted.
She added that the department’s finances have been stretched and impacted negatively due to these fraudulent claims.
“This has affected our ability to provide our day-to-day services because this is regarded as unauthorised expenditure. When the settlement is made that comes out of our annual budget for that year. So, we have accumulated debt, year-on-year since these claims have been escalating in our sector.
“Secondly, our contingent liability has been affected. If you were to take all our liabilities for this year, and we were to settle them this year, this will come to about R22 billion... This is of concern to us because it affects our ability to provide quality care,” she said.
Wagner said the department is also worried that government officials were also involved in the corrupt practice.
“What is more concerning is the abuse by certain officials in the process. What our government in the Eastern Cape has done is that we have launched an integrated medical claims strategy in order to stop the loss of funds through medical claims. In November 2021, we received 43 fraudulent medical claims. We put a case to the court arguing that there must be other ways in which we can make reparations for these cases,” she said.
On Saturday, the minister granted lawyers who submitted fraudulent claims to the department two weeks to withdraw their submissions.
Wagner said some practitioners were deliberately abusing the system for their own self interests, adding that the department, through its forensic arm, is aware of Nonxuba and some of the cases being investigated.
“Government has been aware of it and in fact, our forensic treasury has established a medical legal intervention unit. They have been investigating these cases where we have made medical settlements and there were 397 out of the 412 cases where medical legal cases. In those investigations, they were looking for three kinds of cases.
“They were looking at whether there were fraudulent claims, or whether there was over-billing and trust fund irregularities. There were 140 cases that were associated with four firms that had such irregularities,” she said.
The Chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, has welcomed the investigation.
He said the findings presented by the SIU reveal a disturbing pattern of fraudulent claims, unethical practices, and collusion among legal practitioners, healthcare professionals, and even some officials within the system.
“Such actions not only undermine the credibility of our healthcare services but also divert essential resources away from patient care,” Dhlomo said. | Additional reporting by Se-Anne Rall
The Star
siyabonga.sithole@inl.co.za