The payment trend on medico-legal claims instituted against the Department of Health in the nine provinces grew by a 10% rate between 2017/18 and 2022/23, according to Special Investigating Unit (SIU) head Andy Mothibi.
The nine provincial departments paid R265million in 2012/13, but the amount ballooned to R2.6 billion in 2022/23.
Mothibi disclosed the details when briefing the standing committee on public accounts (Scopa) on Wednesday where he called on the state to make “drastic interventions”.
“We say there is a requirement for a drastic intervention, either legislative or administrative, to mitigate and curb the losses,” he said.
The SIU was granted a proclamation in 2022 after investigating claims in the Eastern Cape by Nonxuba Incorporated, which is now facing court action, that targeted cerebral palsy.
Mothibi said they have made various findings that were concerning and also showed how vulnerable the health sector was and how abusive stakeholders have been.
These included evidence of collusion between attorneys, touts, nurses and doctors in both public and private health care.
Nurses stole medical records and illegally handed them over to attorneys, and litigating attorneys would even sue for one case in two different courts. There was also collusion involving some officials in the Office of the State Attorney wherein out-of-court settlements for hefty sums were entered into without the mandate of the department.
The SIU found that some law firms withdrew their claims when it started investigating the claims they had instituted.
According to Mothibi, their findings have produced interventions aimed to assist the Department of Health.
“The department is in a better position to say what interventions are under way.
“They could apprise the committee about them.”
Scopa heard that 95 investigations have been concluded and 54 cases of actual fraudulent medico-legal claims were identified.
Referrals for administrative action have been made to various bodies with 61 to the Legal Practitioners Council against attorneys and law firms in matters valued at R610m; 45 others to the Legal Practitioners Fidelity Fund totaling R279m; and 54 to the National Prosecuting Authority valued at R374m.
“The actual loss prevented has a potential to exceed R4bn.
“The quantification will be achieved once the amounts of R661m and R657m, which we have referred to the Gauteng Department of Health and Limpopo Department of Health, respectively, are removed from the Contingency Liability Register,” he said.
Scopa chairperson Songezo Zibi said the SIU report was “extremely depressing” given what was going on there.
EFF MP Veronica Mente wanted to know “the characters” implicated in the medical claims, such as the medical officials, law firms, hospitals and attorneys, including those who withdrew litigation after the SIU probe started.
Cape Times