Retired surgeon and former medical school dean must repay R7m medical aid error

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The Grahamstown High Court has ordered a retired Mthatha surgeon and former medical school dean, to repay the R7m mistakenly put into his bank account by Metropolitan Health, reports the Daily Dispatch.

Professor Lizo Mazwai, who is also a former long-serving dean of Walter Sisulu University medical school, fought tooth and nail in court against paying back the money to Metropolitan Health, saying he had blown the bulk of it as he had believed it to be a legitimate pension payout. But he will now have to find a way to pay back Metropolitan Health some R7.08m plus interest of 9.5% backdated to January last year.

Acting Judge Nicola RedpathMolony also ordered him to pay all the legal costs of the application, including what is likely to be a hefty bill from senior counsel advocate Chris Eloff, who argued the matter on behalf of Metropolitan Health. He will also have to pay his own legal team, which included senior counsel advocate Dali Mpofu.

The report says according to court papers, Mazwai’s account administrators, Medical EDI Services, which assists doctors to submit claims to medical aids, filled in an incorrect amount in what was termed the software’s “multiplier column”. So instead of claiming for one operation at a cost of R, 800, it had claimed for 2,469 operations at that price. The result was a hefty bill of more than R7m being submitted to Metropolitan Health, which administers claims on behalf of the Government Employees Medical Scheme (Gems).

Metropolitan’s computer software had not picked up anything odd and it had approved the payment. Gems had duly paid Mazwai. Mazwai used the “windfall” to pay off debts and make various investments. There was only R2.5m left which he had put into an interest-bearing trust account with his attorney.

The report says he had refused to pay even the remaining amount to Metropolitan Health. He questioned Metropolitan Health’s standing to come to court to claim the money back when it was technically Gems that had paid him out the amount.

But acting judge Redpath-Molony said it was clear that Metropolitan Health had paid Gems out for the mistake it had made and Gems had, in turn, legally ceded its claim against Mazwai to Metropolitan Health. She also dismissed Mazwai’s claim that the money must have been put into his account as part of a money laundering scheme.

Daily Dispatch report (subscription needed)

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