Hawks probe medical aid racket

2011-09-18 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

  • Captainmorgan - 2011-09-18 12:46

    Disgruntled emlpoyees/ex-employees can be very valuable in cases like these

  • Ian - 2011-09-18 12:50

    doctors, lawyers, politicions and now medical aid scemes, thieving , corrupt scum of the universe, but hey i pay my medical aid premium without fail even though the scum doctors go out of there way to make you sicker just so they can milk you medical aid for as much as possible, hawks should investigate the doctors too, very interesting amount of corruption will be found

  • Jimmy636 - 2011-09-18 12:54

    lets see how far this goes. all medical aid schemes are ripping us off one way or another, what with the competitions commission letting doctors and hospitals name their own rates, carving up the industry amongst themselves. added to this, the medical aid schemes increase their premiums annually by more than the cpi/inflation rate, most of the time by double the inflation rate, and for what -fewer services and more exclusions? the entire medical aid industry needs to be sorted out and brought to book.

      Margaret2 - 2011-09-18 15:33

      The medical aids try to control the rates that medical services providers charge by having networks of medics that charge the rates that med aids think are reasonable. The problem there is that members of med aids then say that they are being discriminated against if they want to go their choice of medic/hospital who charges way above that and they don't get a full refund. Medical aids, by law, are not for profit organisations, and their only income is the member subscriptions. Any operating profits must go into the reserives of the fund - there are no shareholders benefitting. One of the big reasons that medical inflation is way ahead of CPI is that people want all the latest in terms of the likes of cancer treatments, etc which have an exponential inflation rate. You can have a medical inflation rate in line with CPI if you are prepared to do with the basics or old fashioned treatments for cancer

      Collitjies - 2011-09-18 15:45

      You have hit the nail fairly and squarely on the head, they are all corrupt. Every year the subs increase and their services to us stupid people get less and less.

  • umlaut - 2011-09-18 12:57

    Well we are not surprised--SA is known as the new corruption heaven and all will want to join in--why can only some enjoy the good life, hey !!!?

  • Captainmorgan - 2011-09-18 13:11

    I wonder what they will discover(y) next???

      CTatheist - 2011-09-18 14:10

      Yep, only problem is many top officials have shares in them.

      Margaret2 - 2011-09-18 21:04

      @CTatheist - medical aids are, by law, not for profit organisations. There are no shares or shareholders. Don't confuse the medical aid with the holding company and its other subsidiaries which are profit making entities.

  • Collitjies - 2011-09-18 15:48

    At all South African universities one can now do a degree in corruption, it seems all the lecturers are Nigerians.

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