Saturday, December 2, 2023

Bokamoso Hospital disowns doctors as BHPC probes alleged medical aid fraud

While the Botswana Health Professions Council (BHPC) confirmed that it has launched a massive probe into allegations that some health practitioners have swindled patients off large sums of money, Bokamoso Private Hospital has distanced itself from the alleged fraud saying the doctors in question are not its employees. 


This follows a report that was filed with AFA (fund administrator of BPOMAS and PULA medical aid schemes) and BOMAID medical aid by a former doctor at the hospital Heiner Knab alleging fraudulent billing system by some doctors at the hospital. He alleged that the doctors in question had swindled off patients money running into millions of Pula.


This week, BHPC’s Boago Modiitsane said “Yes, I can confirm that not long ago one Medical Aid Administrator has approached BHPC to look into billing practices of one of our registrants. The complaint as mentioned above is still under investigation.”

He said since the complaint is recent and as such no action has been taken against anybody. “Notwithstanding, it should be noted the BHP Act prohibits any conduct that is deemed derogatory to reputation of profession(s) and that disciplinary proceedings may be taken against health professional(s) engaged in such conduct,” said Modiitsane.

For her part, Bokamoso Private Hospital spokesperson Mmabatho Amelia Mokabedi said “We place on record that the Anaesthetists are Independent Contractors/Service providers who are not in the employ of Lenmed Health Bokamoso Private Hospital (Pty) Ltd (hereinafter referred to as “Bokamoso Private Hospital”).”


She added that “These Specialists however enter into an “Admission Rights Agreement” with Bokamoso Private Hospital in which it is agreed, inter alia, that all parties shall strive to achieve our vision to become a centre of excellence in private healthcare. We reserve the right to terminate any Admission Rights agreement with any Specialist should they fail to adhere to the contractual obligations and objectives of said Agreement.”


Mokabedi said the Specialists enter into separate contracts with medical aid schemes in which they bill these respective medical aids directly via their private practices for any professional services rendered.


“The Medical aids should and surely will take the necessary action (be it legal or otherwise) should any Specialists be found guilty of not charging in line with their contractual obligation to such a scheme and its members,” she said.

She pointed out that Bokamoso Private Hospital “takes a zero tolerance on fraud on all levels and we currently await the outcome of the findings of the Medical Aid Funds / Botswana Health Professional Council investigations where after we shall take the necessary steps herein.”


“Note further that Bokamoso Private Hospital bills the relevant medical aids for allowable hospital related charges i.e. ward fees, theatre time, pharmaceuticals in terms of our contract as entered into with the medical aids. We make use of a state-of-the-art billing system ensuring that the hospital billings for hospital related allowable charges are in line with Medical Aid requirements. We have the best interest of patients at heart at all times,” said Mokabedi.

She further stated that “We reiterate that Bokamoso Private Hospital does not have any locus standi nor is it a party to contractual matters between Specialists and Medical Aids with regards to billing of their professional fees. We shall however in terms of our Admission Rights Agreement take any steps deemed necessary once in possession of the findings.”

AFA Managing Director, Duncan Thela said as administrators of BPOMAS and PULA medical aid schemes they have done their “own internal investigations to establish what administrative issues exist/existed and where such exist/existed have engaged the concerned service providers with a view to resolving the issues.”

He said where there has been no mutual agreement on the way forward with respect to the application and/or interpretation of the administrative processes, they have resolved to refer the issues to their principals (Boards and/or Principal Officers of our administered schemes) for appropriate decisions and/or referred the said matters to the appropriate regulatory/legislative body; depending on the nature of the matter at hand.


“You may be aware that some of the issues in question had already been referred to the relevant regulatory bodies (e.g. Botswana Health Professions Council) and some were/are now part of cases before the Courts,” said Thela.


However, as administrators of BPOMAS and PULA, they continue to profile all healthcare service providers with a view to engaging any service provider, should we identify untoward trends.


“Such engagement are first and foremost aimed at achieving mutually agreed resolution of issues, ensuring a change in any untoward behavior and continually facilitating access by beneficiaries of our administered schemes to quality affordable private healthcare on a sustainable basis,” he said.


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