Unscrupulous and greedy lawyers and advocates have attempted to swindle billions of rands from the State and embezzled monies from their ill clients through fraudulent and irregular medico-legal claims.
This was revealed by Health Minister Dr Aaron Motsoaledi during a media briefing held on Saturday.
The Special Investigating Unit (SIU) has been, through a proclamation, investigating medico-legal claims against the State since 2017, in which allegations of fraudulent claims have been uncovered.
“So far, in the matters completed by the SIU, the sum of [at least] R3 billion has been saved for various Departments of Health. We believe that this amount will increase as the investigations are still ongoing,” Motsoaledi said.
The damning and ongoing investigation by the SIU has revealed that some legal practitioners have been targeting provincial Departments of Health – at times with the help of health practitioners working for the State.
“[The] Department of Health noticed several claims which were completely out of sync and made no sense at all. There were claims that were evidently fraudulent.
“Just as an example, a claim was submitted in which the claimant demanded R70 million for a supposedly botched circumcision by a doctor in a hospital in Limpopo province. On investigation of this claim, it was found out that no such circumcision was ever performed,” Motsoaledi said.
The Minister explained that during the investigation, it was revealed that during 2015, the number of medico-legal claims grew exponentially.
“This explosion happens to have coincided with the Road Accident Fund (RAF) strengthening its systems. It is common cause that RAF had been hollowed out by a multiplicity of claims that brought it to its knees.
“In the aftermath, legal practitioners who used to litigate against RAF seem to have migrated en masse to the health care sector. In response, the Department of Health convened a medico-legal claim summit in 2015,” Motsoaledi said.
In the main, claims against Health institutions were “targeting cerebral palsy, a condition in which babies develop some form of brain damage due to depravation of oxygen during the process of birth”, the Minister said.
Grandparents taking care of children left behind by their parents were also targeted.
“While it is recognised that cerebral palsy is a very debilitating and unfortunate occurrence to come from the health care system, it is a matter of very serious concern that it is abused by legal practitioners, due to sheer greed. The level of abuse was such that the SIU found that some of the claims were made on behalf of patients without their knowledge.
“Elderly people, who are taking care of their grandchildren in the absence of their mothers, were tricked into signing the Power of Attorney to sue, whereas they were told that they were signing SASSA forms for child support grants. This simply means that legal practitioners or their scouts were masquerading as social workers,” the Minister said.
Eating at the trough
The provincial breakdown of medico-legal claims investigations finalised by the SIU is as follows:
- Eastern Cape: 89 matters to the value of R1.2 billion (unfinalised matters: 108 matters to the value of R2.6 billion)
- Free State: 30 matters to the value of R280 million (unfinalised: 22 matters to the value of R120 million)
- Gauteng: 58 matters valued at R66 015 234 (unfinalised: 2 392 matters valued at R23 783 535 552)
- KwaZulu Natal: 107 matters valued at R2 416 284 800 (unfinalised: 1 420 matters valued at R18 020 272 612.60)
- Mpumalanga: 902 medico-legal claims unfinalised investigations valued at R10 115 964 997.77
- Limpopo: 63 medico-legal claims valued at R139 753 944.09 (unfinalised: 698 medico-legal claims valued at R2 732 710 053)
- Northern Cape: one medico-legal claim finalised valued at R23 250 000 (unfinalised: 19 medico-legal claims valued at R535 305 250)
- North West: 12 medico-legal claims to the value of R32 million (unfinalised: 20 medico-legal claims to the value of R190 million)
- Western Cape: Preliminary assessment of raw data/databases of claims provided by the Office of the State Attorney is still underway.
Lawyers and advocates who have been found to have been submitting fraudulent claims have been referred to the National Prosecuting Authority for criminal prosecution and to the Legal Practice Council for violation of the Code of Conduct for Legal Practitioners and the Legal Practitioners Fidelity Fund (LPFF) to consider reimbursing claimants whose funds were embezzled by their legal representatives.
“We wish to take this opportunity to make an offer to lawyers, who might have knowingly submitted claims that are fraudulent, to withdraw them within two weeks and there will be no consequences. Failure to withdraw within two weeks would mean that the offer will have lapsed and the SIU will strike,” Motsoaledi warned. – SAnews.gov.za
