Compensation Fund accused of thwarting doctor fraud case

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The Labour Department’s Compensation Fund is being accused of allegedly frustrating a R12.1m fraud case against a doctor in North West by failing to commission a forensic investigation in the past eight years. According to a City Press report, the Hawks said they had collected all statements and records on Dr Sello Ntsoko, a general practitioner in Lethabile near Brits, who allegedly made fraudulent claims. However, their case has not made progress because the Compensation Fund failed to source an outstanding forensic audit report.

The report says Ntsoko allegedly defrauded the fund in 2009 by submitting fraudulent claims totalling R12.1m in four months for 54 patients. He claimed he had allegedly treated them for occupational injuries and diseases. He also allegedly charged no less than R4,000 for a consultation.

He was allegedly caught out when former Compensation Fund risk manager Twana Makhubela enlisted three forensic audit firms in 2009 to conduct data analysis on 1,919 invoices. This initial audit identified several anomalies, but there was no full-scale investigation. The analysis found that some of the patients did not even consult Ntsoko and were treated by other doctors.

Hawks spokesperson Brigadier Hangwani Mulaudzi said in the report that the police could not be blamed for the lack of progress in the case. “Charges (against Ntsoko) have not been formulated pending the finalisation of the forensic report. All other statements and records have been collected,” he said. “It is unfortunate that the matter of the forensic report rests with the complainant (the Compensation Fund). It is the only thing outstanding that would enable us to finalise the case,” Mulaudzi said, adding that they believed they had “a watertight case”.

The report says that at least six prosecutors who dealt with the case were frustrated by the Compensation Fund’s inaction, so they abandoned the case.

“Our multidisciplinary approach has necessitated us to work closely with the NPA (National Prosecuting Authority),” Mulaudzi said. “The same message was conveyed to the Compensation Fund to finalise outstanding issues to allow the Hawks and the NPA to finalise the matter. It is long overdue.”

A source with knowledge of the investigation is quoted in the report as saying that Ntsoko seemed to enjoy protection from the fund’s employees. “At the time of the initiation of the investigation, a criminal network existed within the fund that recruited doctors to submit fraudulent claims,” the source alleged.

The source said Makhubela, who has since become deputy director of information security at the Compensation Fund, had undertaken to appoint a forensic audit firm to conclude the investigation, but nothing happened. His successor, Katlego Mocwiri, also did not deliver. “In 2015, quotations were called for from Kwinana & Associates to finalise the forensic report,” said the source. He said that nothing was done and this delayed the investigation.

The report says Makhubela confirmed the forensic investigation was not done, saying he could not comment fully on the case because he did not have the file, which would only be available next week, when officials returned from leave. Makhubele said Ntsoko had submitted more claims worth more than R1m, but these were not paid because they were also suspicious.

He said two clerks were fired for their role in the scam, but they were not criminally charged. “We did not see that it was reasonable to spend another R3m (on a forensic investigation) because we had evidence. Prosecutors said we must go and get statements from each and every patient. We said we cannot because some could not be traced or had died,” he said.

In 2010, the report says, the NPA’s Asset Forfeiture Unit seized Ntsoko’s properties. It seized R3m, two BMW 3 series, a BMW 1 series, a Mini Cooper and a vacant stand valued at R280 000 in Amandasig, Pretoria. Ntsoko failed in his appeal against the Asset Forfeiture Unit in 2015.

Ntsoko said he could not comment because his lawyers were overseas.

City Press report

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