Elderly people taking care of their grandchildren in the absence of their mothers were tricked into signing Power of Attorney documents to sue the Health Department, while they were told they were signing SA Social Security Agency (Sassa) forms for child support grants.
“This simply means that legal practitioners or their scouts were masquerading as social workers,” said Health Minister Aaron Motsoaledi.
He made the remarks during a briefing at the weekend about the ongoing investigations by the Special Investigating Unit (SIU) into medico-legal claims lodged against the Department of Health across the country.
The SIU began their work in 2017, specifically looking into these medico-legal claims by targeting provinces with the highest share of claims. These were in Gauteng and the Eastern Cape.
There were 2 500 medico-legal claims valued at R22.3 billion in the Eastern Cape.
The SIU is investigating 197 medico-legal claims valued at R3.8 billion.
The Health Department has paid R3 039 951 634 towards medico-legal claims over the period 2015/16 to 2020/21.
The SIU finalised its investigations regarding 23 letters of demand where lawyers were demanding R298 million, with most of it found to be fraudulent.
“Fifteen of these 23 letters to the value of R271.8 million were fraudulent because the claimants told the SIU investigators that they had never visited any of the health facilities that were being litigated against, and indeed no records of these patients were found in those facilities.
“Notably, all these letters were submitted by a single law firm, but we are unable to mention the name because they have not yet been charged in a court of law.
“There are 35 additional matters valued at about R600 million, currently under investigation, initiated by Nonxuba Attorneys Inc, in which no trusts were registered as per the court orders.
The SIU has made 45 referrals of attorneys to the NPA, amounting to R279.5 million, for consideration of criminal charges related to fraud, theft, embezzlement of trust funds, and contempt of court against certain legal firms, including Nonxuba.
Motsoaledi said the collusion was so entrenched that it also included nurses and doctors in both the public and private healthcare sectors.
“In some instances nurses stole the medical records and illegally handed them over to attorneys.
“Unfortunately there was also collusion involving some officials in the Office of the State Attorney, whereby out-of-court settlements for hefty sums were entered into without the mandate or even the knowledge of the department.
“Litigating attorneys would even sue for one case in two different courts,” Motsoaledi said.
The Department of Health also 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.
On investigation of this claim, it was found that no such circumcision was ever performed.
“It was found that the patient was actually treated for a very serious genital infection. The hospital actually saved his life.”
The SIU further identified cases in the Eastern Cape where the living conditions of the claimants and their children “remain appalling”, despite receiving compensation from the department, where money had been paid to their lawyers. “Many of these claimants are unemployed and rely on social grants from Sassa for their livelihood despite millions having been deposited into their lawyers’ accounts. Some households are constrained to a single-room ‘rondavel’ without appropriate railing or ramps to assist disabled children, resulting in inadequate living conditions and insufficient caregiving, despite the fact that in the claims, money has been paid for these types of facilities.
“Further, the SIU found that these children continue to place a burden on the already strained public healthcare system, whereas in the claims in court the lawyer cited future healthcare based on fees charged in private hospitals,” said Motsoaledi.
The Western Cape had 409 medico-legal claims to the value of R2 852 588 055. The SIU identified 33 fraudulent birth injury claims in the contingent liability register to the value of about R409 million.
The total amount paid by the department towards medico-legal laims for 2015/16 to 2020/21 was R273 248 535.
Gauteng had 2 450 medico-legal claims valued at R24 445 550 786.
There are currently 611 matters under investigation valued at R4 175 863 219.
Motsoaledi called on lawyers who might have knowingly submitted fraudulent claims 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.”
The Democratic Nursing Organisation of SA (Denosa) said the causes of medico-legal cases and prevention mechanisms were not factors outside of the department’s control.
“The silence by the department on how it plans to curb the increase of these indicates some hopelessness and lack of will and urgency on its part to weed fraud out of its system.
“For example, improving record keeping measures by introducing improved health information systems and management has long been identified as an area that needs special and urgent attention as it could potentially eliminate all forms of fraud and unethical behaviour where patient records are stolen easily from where and how they are kept,” said Denosa spokesperson, Sibongiseni Delihlazo.
Staff shortages in critical healthcare service areas like maternity, where cerebral palsy cases in children emanate from, has become the norm in many public health institutions where midwives were in short supply.
Those who were at work were often forced to administer natural deliveries on more than three patients at once in a ward, according to Delihlazo.
“Denosa believes the Department of Health also needs to conduct self-introspection on whether it is not inviting this flurry of medico-legal litigations upon itself.”
Cape Times