The Fraud, Waste and Abuse Indaba hosted by the Board of Healthcare Founders was held at the Houghton Hotel yesterday.
The event saw prestigious attendees coming together to understand and unpack challenges that the health sector finds itself drenched in.
The impending need for collaboration in the sector was mentioned as one of the pivotal points, indicating that most of the rife fraud experienced in the sector had to do with entities not engaging with each other on a regular basis, according to Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders.
Professor and Advocate Thuli Madonsela gave the keynote address for the day. She spoke about strengthening a culture of integrity and accountability, as well as new strategies for a corruption resistant future.
“R30 billion is lost to fraud. Need, grievance and greed are the main drivers of fraud,” she said.
Madonsela added that developmental corruption was fast becoming a growing trend in South Africa.
“Employee fraud, where an employee makes up false claims, is part of developmental corruption as it plagues the system with the wrong information. Another type of fraud is done by brokers. This one is called brokers fraud. Here, brokers tell their clients to lie about information so they can claim money. Corruption starts with the little things then eventually grows into something that cannot be controlled.”
Madonsela highlighted seven ways in which fraud is committed by service providers:
- False claims/ false billing- this is when a billing is made for something that has not been done. The building of incomplete houses for example.
- Irregular billing of codes used for medical aid/ over billing – this is when a person uses a code for a higher service than the one they provided. Take the billing of eye glasses for example. Billing a customer a higher amount based on a minor service is also fraud.
- Excessive billing- not charging for the actual cost of the service.
- Provision of unnecessary services – this would be where somebody doesn’t have high blood pressure and perhaps has a heart condition, but instead of only giving them medication for their heart condition, they are given high blood medication, adding to a problem that could’ve been easily solved. The same thing happens in government, says Madonsela, where services are provided that government does not need.
- Duplicate claims – the act of billing twice has been on the rise.
- Billing for products – this includes billing clients for products that don’t exist.
- Unlicensed service providers- Here, Madonsela made the example for the recent Dr Matthew Lani scandal, adding that she first laughed when she saw the headlines around this story but was later forced to think of how many other service providers were probably doing the same thing.
Giving a special address, Ben Theron, Chief Executive Officer at The Whistleblower House NPC, spoke about promoting the culture of whistleblowing and protecting the whistleblower.
Whistleblowing is the act of providing law enforcement with reliable, relevant information on illegality such as corruption or fraud. Anyone witnessing unlawful actions that improperly use state funds or resources can responsibly come forward. The protection of whistleblowers has come into question seeing that they have suffered severe consequences. This includes physical harm, intimidation, and loss of jobs and career prospects. Some have even been murdered. Others have fled the country, fearing for their lives or safety. A clear indication that there isn’t enough being done to protect them.
“Whistleblowers are outcasts in society. They suffer from PTSD. They have died for the sake of honesty. To date, 234 people have been helped by the NCPC so far, 109 have seeked counselling, 213 have gotten legal assistance, 66 have gotten help with safety and security and 55 are in need of financial help,” said Theron.
According to Theron, each whistleblower is currently getting paid R15 000 a month for 6 moths which is all they can afford, saying ultimately, it is the state that suffers.
“R80 million is needed to fully take care of whistleblowers,” says Theron.
A case study by Julia Tloubatla who is in charge of monitoring and analysis at the Financial Intelligent Centre, was based on South African businessman, Hamilton Ndlovu. The case study detailed how Ndlovu brought the attention of the Special investigating Unit to himself by flashing his luxury life on social media. It was later found that Ndlovu scored close to R172 million in personal protective equipment (PPE) contracts from the National Health Laboratory Service (NHLS) through entities directly and indirectly linked to him in 2019. It gets worse. A report by the SIU indicated that Ndlovu used a series of companies to compete for contracts worth millions. A growing fraud trend that many were getting into for making easy money.
Other speakers of the day included Charlton Murove, head of Research at BMF (Board of Healthcare Funders) who spoke on Rent seeking in the healthcare system, Dr Debbie Pearmain, who is an Independent Legal Expert, was talking about strategies for successful civil claims and recovery in healthcare and Ashley Wilson, who is a legal prosecutor, addressed the training gaps to improve healthcare related prosecution.
The event gave a directive on the current state of the healthcare environment in South Africa.
Main image: Medium
