Saturday, December 3, 2022

Medical Aid Schemes probe alleged hospital fraud

Medical aid schemes have confirmed that they are investigating allegations that some medical doctors based at BOKAMOSO Private Hospital have fleeced their clients of millions of Pula. This follows a report 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.

“Yes we do confirm that as Southview (Pty) Ltd, the Administrators of BOMaid, we have been made aware of some ‘fraudulent and/or unethical billing practices’ by some Doctors at Bokamoso Private Hospital,” said Dr Lorato Mangadi, South View’s Divisional Manager (fund administration). Mangadi added that, “We are looking into the matter and will take the necessary action depending on what the outcome of our investigations will be.” According to Mangadi, they are mandated by their client BOMaid to look after its members and this includes putting necessary measures in place to protect them against any unfair and unethical practices by contracted Health Care Providers. Mangadi also confirmed that they have received a complaint from one of the BOMaid “members relating to this same matter and we are still looking into it.”

AFA Managing Director, Duncan Thela said as administrators of BPOMAS and PULA medical aid schemes they have started investigations to establish the veracity of the allegations so that administrative action(s) available to them “can be called upon or taken to protect their clients should it be necessary.” “I wish to confirm that Dr Knab and I met on 20th October and during our meeting he alleged that there was some fraudulent billing by some doctors at the BOKAMOSO Private Hospital. I wouldn’t rather consider what transpired a lodgement of complaint but rather an alert to us of certain allegedly improper practices by some doctors,” said Thela.

Thela added that “you may note that in view of the nature of the allegations (legal and professional issues) we would also rely upon the Botswana Health Professional Council (BHPC) to investigate and take appropriate action or refer the issue to the relevant authorities for action.” He also confirmed that where they had received complaints of over charging from their clients they have engaged the concerned practitioners with a view to obtaining resolution. “You may also note that in view of the involvement of the regulator, BHPC and assuming that BHPC is investigating the issues we neither wish to nor want to jeopardise their investigations.

However as already stated, we shall take appropriate action(s) post our investigations to protect our clients,” said Thela. Knab says in his report that there are other examples where patient’s wellbeing has been put at risk, with monetary aspect being the driving force for their action while compromising patient’s interest. “Some of them(incidents) have been reported to the CEO-with no consequences whatsoever to any of them; in fact the CEO who is a non medical person with little ability to judge over possible malpractice has chosen in each and every case to not even bring the matter to the in House Peer Review Committee, where a selected group of different specialist would be suitably educated to evaluate these allegations ÔÇô and again the motives for such protection must be questioned,” states Knab in his report.

On concerns that BOKAMOSO Private Hospital is failing to take action against the doctors in question as it did not bring the matter before the House Peer Review Committee, the hospital’s Chief Executive Officer, Reuben Naidoo said “The peer review is run independently, what complaints is he (Knab) referring to? All matters on review were discussed and we do not know what he is talking about. Please look into his medical conduct at BHPCA.”


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