Johannesburg psychologist pleads guilty to medical aid fraud

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A health care practitioner has been convicted and sentenced for defrauding the second-largest open medical aid scheme of R87,000. The Star reports that Johannesburg clinical psychologist Henny Tinyiko Mavasa, had been submitting fraudulent claims to Bonitas Medical Aid Scheme members for more than two years.

He was found guilty by the Johannesburg Specialised Commercial Court of medical aid fraud and of 60 counts of contravening Section 66 of the Medical Schemes Act.

The report says Mavasa pleaded guilty last week under Section 105A of the Criminal Procedure Act 77 of 1951 and sentenced to a fine of R60,000, or three years in prison. He was sentenced to a further three years imprisonment, suspended for five years by the court, which noted that he had already paid back the R87,000 to Bonitas.

The report says on 1 August, Pretoria audiologist and speech therapist Wandile Theophilus Mashego was found guilty of defrauding Bonitas Medical Aid Scheme of R506,000, and was ordered to pay back the money. He was found guilty of 259 counts of medical aid fraud and one of contravening Section 66 of the Medical Schemes Act.

The report says as part of his sentence, Mashego had been ordered to subject himself to stringent conditions including house arrest, a suspended prison sentence, community service and correctional supervision.

Bonitas chief operating officer Kenneth Marion said: “The repercussions of fraud are widespread, but it has a direct impact on every member of the fund.

“Medical schemes are not for profit and are in fact owned by their members. So, when the scheme is defrauded, it impacts funds to pay for claims and can contribute towards increased premiums. Last year R31.2m (fraud money) was recovered.”

He said fraud and abuse is committed by a small number of health care providers, but was a major cost-driver in terms of financial impact, which adds between R192 and R410 per month to every principal member’s medical aid contributions.

The Star report (subscription needed)

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