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Hawks probe medical aid racket

Sep 18 2011 11:47

Johannesburg - The Hawks are investigating corruption in the medical aid industry and have already raided 12 premises, the Sunday Times reported.

Trustees of two medical aids, Hosmed and Commed, allegedly worked with officials from the Council for Medical Schemes, the industry regulator, to defraud medical aid members, the paper reported, citing an affidavit from police Lieutenant-Colonel Gezina Lottering.

Allegations against these medical aids first surfaced last year, but apparently no action was taken against them.

Administrator Allcare, which looks after the medical aid accounts of 135 000 people, had also been implicated, the newspaper reported.

Lottering's affidavit describes a "culture of dishonesty" at Allcare, including bribery, corruption, and contraventions of the Medical Schemes Act.

She said money was systematically stolen from Commed through the submission of fictitious supplier invoices.

This required the appointment of compliant trustees, who would allow these fake invoices to be submitted.

Commed and Allcare premises were raided by the Hawks as part of this investigation, according to the Sunday Times.

One particular case of corruption detailed by the Sunday Times involved an alleged bribe paid by Allcare to Commed's former chairperson.

David Tsalapedi, a whistleblower fired by Allcare, said in an affidavit that Raato Mogajane, had asked for a R50 000 bribe to ensure Commed retained Allcare as its medical aid administrator.

Mogajane denied taking the bribe, suggesting that Tsalapedi was suffering from sour grapes after his dismissal from Allcare.

Allcare CEO Howard Phillips told the weekly that "absolutely nothing improper" happened at his company and that Tsalapedi was fired because he was dishonest
hawks  |  medical aid  |  fraud


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