Medical Aids: Who's Scamming Whom?

Doctors and pharmacists say evidence is being fabricated to strong-arm money out of them for purported fraud.

- Jonathan Erasmus

FOR YEARS MEDICAL AID PROVIDERS have claimed that medical practitioners were robbing them blind through various in-tricate medical aid fraud scams – fraud that is often blamed for the above-inflation increases that members need to swallow on a yearly basis.

But now a number of doctors are claiming that they are the ones being cheated, extorted and left bankrupt by the very same medical insurance industry, as it attempts to claw back losses that amount to a financial black hole – the industry’s annual losses to fraud are estimated at anything up to R20 billion, depending on the source.

The medical aids’ primary weapon, it emerges, is to pressure accused doctors to sign an acknowledgement of debt (AOD) committing to pay back the money they’ve allegedly stolen.

An AOD seen by Noseweek, that was drawn up by Discovery Health (Pty) Ltd, allows the debtor no slack, even dictating that the debtor cannot raise certain defences in future litigation to get out of the debt, including errore calculi where they could claim the medical scheme made an error in its calculations as to what is owed.

It also states that “by signing this agreement you are exercising your own free choice without inducement or coercion”. Which by several accounts does not quite describe the real situation.

Several practitioners believe they had little choice but to sign the AOD or face financial ruin and huge reputational damage. In one such case Durban pharmacist Previsha Harripersad says she has been fighting Discovery since 2013 over two AODs totalling R1,250,000, which she claims she was forced to sign “under duress”. She claims the “evidence” against her is a complete fabrication and maintains she has been financially ruined by the AOD policy.

However Discovery Health CEO Dr Jonathan Broomberg says Harripersad is telling porky pies.