In 2017 it detected R300 million worth of medical aid fraud, administrator Medscheme said this week.
During the same year the Health Professions Council of South Africa (HPCSA) finalised seven cases where practitioners – a mixture of doctors and other professionals – were found to have over-charged patients in one way or another. Several charged for services they did not deliver. One charged excessive hours with medical aid members, another charged a medical aid for a hearing aid that was never delivered.
Between them, the seven paid admission of guilt fines or were fined a total of R145,000 – a little less than 0.05% of the value of the fraud Medscheme detected, and described as the tip of an iceberg.
None of the practitioners were suspended – although one had a one-year suspension suspended for another year. Another was made to serve four hours of community service per week for six months. That service was to be in the training of psychiatry students.
The HPCSA is a statutory body to protect the public and, indirectly, the professionals it regulates. Health professionals are forced to register with it, and it has wide ranging powers to regulate them.
The largest fine the HPCSA levied for over-charging was R70,000, paid by a doctor found guilty of five counts of drafting an account to prejudice a fund. Two others paid fines of R5,000 each. One doctor paid a R10,000 fine without ever appearing at an inquiry.
"There is real injustice because of a lack of consequences," says Paul Midlane, forensic manager for Medscheme. "There are cases where you have R3 million in fraud and they get a suspended sentence of R15,000, which they only have to pay if they do it again."