Fresh fraud allegations against suspended CMS investigations head

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The suspended head of investigations at the Council for Medical Schemes (CMS) is facing new allegations that he facilitated the curatorship of a municipal workers medical scheme to further his own interests, reports Business Day. Stephen Mmatli, who was suspended in early February pending the outcome of an inquiry into alleged corruption and misconduct, has been accused by the former deputy chair of the SA Municipal Workers Union National Medical Scheme (Samwumed), André Maxwell, of using his influence at the CMS “to set in motion a series of staged events to bring down the scheme, its board and key officials”.

The report says Samwumed was placed under provisional curatorship in May 2018 because its board was dysfunctional. It was then embroiled in a series of legal battles that ultimately saw the removal of provisional curator Duduza Khoza and the appointment of curator Joe Seloane in October. Maxwell and several other former trustees had asked the Cape Town High Court to remove Khoza, arguing that her decisions were doing irreparable harm to the scheme.

Samwumed had a poor relationship with Mmatli and the CMS since it challenged provisions in the Medical Schemes Act that require schemes to fully fund members’ claims for prescribed minimum benefits (PMBs), regardless of what the healthcare provider charges, Maxwell is quoted in the report as saying. PMBs are a basic basket of conditions that all schemes must cover.

Maxwell said Samwumed had been placed under curatorship without an inspection and despite the fact it was in sound financial health. “It begs the question what were the ulterior motives of Mr Mmatli,” he wrote. The scheme’s board had laid an official complaint against Mmatli and other CMS officials, but the matter had been “mysteriously withdrawn” by the acting curator in 2018, he said.

Maxwell said he had repeatedly requested a copy of the CMS board resolution and minutes for the curatorship order, but these documents had yet to be provided. “I thus have strong reason to believe that Mr Mmatli misled the CMS into destroying the scheme, the board, and key officials for personal gain,” he wrote.

The report says Maxwell also questioned the curator’s decision to sell scheme assets, including a clinic and land in Cape Town, and why the curator had yet to call an annual general meeting to elect a new board of trustees.

The report says CMS did not answer detailed questions put to it, saying it did not want to respond to Maxwell’s accusations in the media. Its head of stakeholder relations, Grace Khoza, said the issues Maxwell raised were not part of the CMS’s investigation into Mmatli, but it would respond to them in conjunction with Samwumed’s curator. Mmatli responded through his lawyer, Hope Chaane, who said the issues raised by Maxwell largely related to the scheme being placed under curatorship.

“This is a CMS process and the decision whether to place any medical scheme under provisional curatorship finally lies with the court. It is totally impossible that our client could have had influence on Samwumed being placed under provisional curatorship,” Chaane said is quoted in the report as saying.

“In simple terms evidence was placed before court, the court analysed the evidence and the court came to the conclusion that Samwumed must be placed under provisional curatorship,” he said.

Business Day report

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