Government Employees Medical Scheme loses over R 2million on fraudulent claims
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A fraud case which saw Government Employees Medical Scheme (GEMS) a little over R 2million has been postponed to 23rd March 2023 pending further investigations.
Mpumalanga Hawks Spokesperson Captain Dineo Sekgotodi said they pounced on 19 suspects including pharmaceutical companies that colluded with clients to make false claims to the medical aid.
The suspects aged between 32 and 66 years old and three entities, Valencia, Nala and Buffelspruit pharmacies appeared before the Nelspruit District Court on Monday, 6 March 2023 after they were arrested by the Hawks Nelspruit based Serious Commercial Crime Investigation for Fraud and Contravention of Medical Scheme Act 131 of 1998.
It is said that the Medical Scheme clients colluded with the mentioned Pharmacies and allegedly made false claims in exchange for cash and purchasing of items that are not covered by the Scheme.
“The allegations relate to the submissions of claims by Valencia, Nala, and Buffelspruit pharmacies to GEMS for services or goods that were not supplied or rendered to the members It is further alleged that GEMS`s members received non-medical goods in lieu of the false claims submissions.”
“GEMS conducted internal investigations to determine the veracity of the allegations of false claim submissions. During investigation, it was discovered that members of the medical scheme colluded with the pharmacy directors, Lucky Velaphi Lubisi, Thabo Ndlozi, Nelile Shabangu and Mukden Mashood to make misrepresentations to GEMS well knowing that, what they were doing was not in line with the prescripts regulating pharmacies as prescribed in the Regulations. The complaint was reported to the Hawks in 2020, whereby investigation was conducted hence the arrest.”
Captain Sekgotodi added that fourteen accused including three entities were released on R1000 bail each, four pharmacists released on R5000 bail each and a pensioner was released on warning with conditions that they should not commit any similar offence to the one they are out on bail for.
They also ordered to appear before the court as and when requested to, in relation to the case.
