The majority of healthcare providers implicated in
the reported criminal cases are speech therapists and
audiologists. Therefore, we are currently enhancing our
efforts to ensure due diligence on claims regarding this
discipline. Four of the convicted healthcare providers
are medical technologists from Limpopo who submitted
false claims for services that were never delivered. They
were charged with 180 counts of fraud, which was made
up of 21 171 claims. Bonitas is constantly engaging with
the police and the crime unit to ensure progress on these
cases.
601 interventions were initiated by healthcare
providers
Steps were taken to recover the money Bonitas paid out to
these providers as a result of their fraudulent behaviour.
Various measures were taken against healthcare
providers who failed to honour the repayment terms.
This included internal controls that were introduced to
identify healthcare providers who evaded the sanctions
imposed. One healthcare provider, practicing as a general
practitioner, was also found guilty of fraud after he
pleaded guilty to the charges against him. This healthcare
provider was also submitting claims to Bonitas members
for services not rendered and using a locum that was
not registered with the Health Professions Council of
South Africa. The provider was sentenced to five years
imprisonment, which was suspended, and a fine of
R185 000 payable to Bonitas by 31 January 2018. In
addition, 52 healthcare providers were reported to the
Health Professions Council of South Africa.
In 2017, we updated our forensic detection
software to detect irregular claims at
pharmacies as well
This increased the identification and confirmation of
fraud, waste and abuse to a total of over 601 healthcare
providers. These interventions further increased the
amount of the identified fraud, waste and abuse by 40%.
Recoveries also increased significantly by 85%. It also
resulted in a positive change in claiming patterns from
healthcare providers. This behaviour change has been
quantified to an amount of R75 million as of September
2017.
Successes did not come without challenges
One of t