Saturday, July 2, 2022

BOKAMOSO Hospital fleecing patients – whistleblower

The Botswana Health Professional Council (BHPC) is studying a strongly worded documents filed by a medical doctor who claims that thousands of patients who visit BOKAMOSO Private Hospital have been fleeced of millions of Pula by some fraudulent medical doctors. The documents which have been passed to the Sunday Standard and filed with BHPC, AFA (fund administrator of BPOMAS, Pula medical aid schemes) and BOMAID medical aid scheme was compiled by a former doctor at BOKAMOSO Private Hospital, Dr Heiner Knab.

In a brief interview with Sunday Standard, Knab confirmed that he had filed the report with BHPC in which he alleges that some anaesthetists based at BOKAMOSO Private Hospital continue to defraud patients out of millions of Pula by “billing for services not rendered at all.” “The total amount of the fraud in my careful view estimate certainly exceeds P3 million since 2012, more likely to be in excess of P5million and recent new evidence that I have been able to collect leaves little doubt that these figures are genuine,” states Knab in his report.

Knab complained against unexplained delays by BHPC in taking action against the alleged fraudulent billing by the medical doctors at BOKAMOSO. “I have experienced unexplainable delays in matters brought before the BHPC that have created major upset for me. I expect the allegations I have laid down here to be true, with the magnitude of it to be researched by the BHPC or other legal institutions. If it appears that I have been misled by a just a few invoices in my hands (which 100 percent show the fraud described) I expect BHPC to act immediately and protect its honest members by showing an immediate and appropriate response,” states the report.

Knab wants BHPC to among others, to question the anaesthesiologists involved, to seize their computers and gather information about the magnitude of the fraudulent billing; to seize documentation from BOKAMOSO Private Hospital.

He also calls on BHPC “to contact the Major Medical Aid schemes in the country (BOMAID , AFA, BOTSOGO) and ask them to provide a list of all invoices submitted before BOMAID by these anaesthesiologists; to possible inform the Botswana Police Service ÔÇôpeople have been prosecuted for much smaller amounts by Ministries but also by Police, and if I am right not hundreds but thousands of members of the public have been affected and will be affected each day until action is taken against this fraudulent scheme.” The report states that “about three weeks ago, one of the anaesthesiologists fled the country without even letting his surgeons know, who now are stranded with no anaesthesiologist to turn to. It is the first sign of a major problem around the corner.”

The report further states that while Medical Aid schemes are not affected, it is their members who have been asked to pay fees not reimbursed by the same Medical Aids Schemes. These include double billing; but more so Tariff Codes for services which have not been rendered at all. “In many cases, the Medical Aid Schemes were not parties affected by this fraudulent way of billing. Had all these Tariff Codes for changes been submitted to the Medical Aid schemes, rendered or not, justified or not, the medical aid schemes sooner or later would have picked up that a group of doctors is again and again submitting charges that either reflect double billing or were services that were not rendered,” states Knab in his report.

“When a patients do complain (as it happened with a Superintendent of the Mahalapye Hospital on behalf of his wife questioned the invoice), he was belittled by the anaesthesiologist specialist and made to believe that the service was rendered while in fact it was not,” states the report. The report states that only an observant ‘insider’ (one competent enough to know procedures of anaesthesia) can understand and comprehend this scheme. It takes true inside knowledge (of anaesthesia billing that is) to uncover this fraudulent scheme,” states Knab’s report. Knab’s report states that medical terminology in Anaesthesia is quite unusual for the ‘lay man.’

The report states that charging tariff 1117; laryngeal intubation (when a general anaesthesia is administered) reflects double billing since tariff code 0023 (anaesthetic time) already includes the laryngeal intubation. “In fact, it seems to have been too sophisticated for most of all the Medical Aid Schemes claims people who were handling invoices. Even when approached by a patient who complained to AFA employee attending to his wife; all they were discussing was double billing, but they never picked up the fact that services charged were not rendered at all and in fact are virtually never chargeable by an anaesthesiologist (direct laryngoscopy vs. laryngeal intubation.”

The report explains that patients’ lack of understanding of the medical terminology is to blame for the alleged success of fraudulent activities by some doctors. “A patient who will receive an invoice will be overwhelmed by the various sophisticated sounding procedures and he or she will always not question the invoice in detail. A patient who has come out of the hospital either a joyful event (caesarean section and birth of a child) is a grateful person and easy to manipulate into delivering that the services charged are genuine,” states the report. The report states that “this billing is not only digging into the patient’s wallet, but may actually be physically harmful for some patients; in the least it compromises the best available services to the patient.”

Responding to Sunday Standard queries, BHPC’s Boago Modiitsane said “Doctor (Knab)has served BHPC with court papers demanding a certificate of good standing. My hands are therefore tied with regards to the questionnaire as the matter is before the courts of law. I deeply apologise that I am not able to assist you this time around. I wish it did not end this way as I had already completed the questionnaire.” However, Knab reiterated that BHPC was dishonest because his appeal relating to fraudulent billing had nothing to do with his court case against the Council.

For his part, BOKAMOSO Private Hospital CEO, Reuben Naidoo said , “if this conduct (by doctors at BOKAMOSO) relates to billing, I refer to the fact that DR Knab charges P84 per unit but the other doctors charge medical aid tariffs which are much lower than his tariff.”


Read this week's paper