Healthcare practitioners stealing from medical schemes by claiming for fictitious treatments is a regular complaint heard by the Health Professions Council of SA, as the latest judgments by its professional conduct committee, from June and July, reveal.
June
Ms AT Sefike (PS0112593-230731- 0543)
Psychologist
Complaint
That you are guilty of unprofessional conduct and or conduct which when regard is had to your profession, is unprofessional in that on or about November 2021, you and/or your practice claimed for services not rendered in respect of two of your patients
Penalty
The Professional Conduct Committee found the Respondent guilty as per the charge sheet and imposed the following penalty: R20 000 fine, suspended for three years on condition that she does not commit a similar offence during the period of suspension
Ms T Abrahams (MT 0106119/23932202)
Medical technologist
Ms N Nxusani (MLS 0000396/23932214)
Medical laboratory scientist
Mr A Beerbal (MT 0106330/23932224)
Medical technologist
Ms Engelbrecht (MT 0068829/23932196)
Medical technologist
Mr Pierdica (MT 0093033/23932184)
Medical technologist
Ms Moloi (MT 0096776/23932240)
Medical technologist
Complaint
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional, in that during the period 2016 and 2020, as a registered medical technologist with the HPCSA in terms of section 17 of the Health Professions Act 1974, you acted in a manner not in accordance with the norms and standards of your profession in that you engaged in an undesirable business practice or model by entering into a contract with a non-approved entity and in doing so, allowed yourself to be exploited in contravention of Ethical Rule 22 of the conduct of practitioners registered under the Health Professions Act, 1974 which prevents a practitioner from permitting herself to be exploited in any manner.
Penalty
The Appeal Committee gave the following order:
The appeal against conviction is dismissed.
Appeal against sentence is upheld.
The sentence imposed by the committee a quo is set aside and is replaced with the following: each Appellant is fined R10 000 payable on or before 31 July 2024.
July
Mr T Lephera (PT 0112399-230303- 000846)
Physiotherapist
Complaint
Count 1
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that on or about July 2023, you contravened ethical rule 20 (a) of the Ethical Rules of conduct, in that you failed to provide an explanation to Council within the stipulated time, thereby, obstructing Council in performing its duties.
Count 2
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that during the period October 2021 to September 2022, or part/s thereof, you and/or your practice acted in a manner that is not in accordance with the norms and standards of your profession in that you fraudulently claimed from a medical aid scheme for services not rendered;
Count 3
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that on or about October 2021 to September 2022, you acted in a manner not in accordance with the norms and standards of your profession in that you failed to keep clinical notes.
Count 4
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that on or about the period October 2021 to September 2022 you and/or your practice acted in a manner that is not in accordance with the norms and standards of your profession in that you have proceeded to treat patients without first obtaining the necessary consent from the patient.
Penalty
The Respondent was charged with four counts of unprofessional conduct and found guilty of all charges and the following sanction imposed: a fine of R10 000, which was suspended, and ordered to attend two HPCSA courses on ethics and practice management with a minimum of five CPD points.
Mr P Peu (PT0116718-230421-004197 PT 0116718/23937278)
Physiotherapist
Complaint
Count 1
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that during March 2021, in respect of your patient, you acted outside scope of practice as a physiotherapist by consulting and prescribing medication to manage your patient who was coughing up blood.
Count 2
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that during the period January 2023 to March 2023, in respect of your patient, you claimed for services not rendered.
Count 3
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that during the period January 2017 to October 2019, the medical aid conducted an audit on your claims and found that you claimed for services not rendered to your patients and thus prejudiced the medical aid.
Penalty
First Matter: The matter proceeded in absentia as the respondent did not attend the inquiry. The Respondent was charged with one count of unprofessional conduct for claiming for services not rendered, found guilty, and fined R25 000 payable within six months from date of the finding
Second matter: The matter proceeded in absentia as the respondent did not attend the inquiry. The Respondent was charged with two counts of unprofessional conduct for claiming for services not rendered and practising out of scope of practice as a physiotherapist by prescribing medication to manage a patients’ condition which is outside his scope of practice. The Professional Conduct Committee entered a guilty plea on behalf of the Respondent. The Respondent was found guilty and the following sanction was imposed:
Count 1
The Respondent is suspended from the register of practitioners for 12 months. During the period of suspension, the respondent is ordered to attend a course on good clinical practice, which course must account for 15 points.
Count 2
The Respondent is ordered to pay a fine of R25 000, within six months from the date of the finding.
Mr M D Nenungwi (OP 0053953/230223- 00118)
Optometrist
Complaint
Count 1
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, read with section 1 of the Health Professions Act 54 of 1974 as amended, is unprofessional in that on or about March 2021 and/or portions thereof in relation to your patient and dependants you and/or your practice intentionally and/or negligently and/or wrongfully and/or unlawfully rendered and/or allowed a statement of account acted in a manner not in accordance with the norms and standards of your profession in that:
1.1. none of the professional services were rendered by you; and/or
1.2. you knew you were not entitled to payment of any of the amounts specified in the said account/statement; and/or
1.3. the said account/statement was drafted in a manner that was inaccurate and/or incorrect; and/or
1.4. there are insufficient records to able to quantify claiming for contact lenses.
The said account was drafted in such a manner as to cause financial or potential prejudice to your patient and/or the medical aid scheme concerned.
Count 2
That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, read with section 1 of the Health Professions Act 54 of 1974 as amended is unprofessional in that on or about February 2022 and/or portions thereof in relation to your patient and dependants you and/or your practice intentionally and/or negligently and/or wrongfully and/or unlawfully rendered and/or allowed a statement of account acted in a manner that is not in accordance with the norms and standards of your profession in that:
1.1. none of the professional services were rendered by you; and/or
1.2. you knew you were not entitled to payment of any of the amounts specified in the said account/statement; and/or
1.3. the said account/statement was drafted in a manner that was inaccurate and/or incorrect; and/or;
1.4. there are insufficient records to be able to quantify claiming for contact lenses. The said account was drafted in such a manner as to cause financial or potential prejudice to your patient and/or the medical aid scheme concerned.
Penalty
The respondent was found guilty on count one (1) and sanctioned as follows: R70 000 fine, half of which was suspended for three years on condition he is not found guilty of a similar offence during the period of suspension. The other 50% is payable within six months starting on 1 July 2024.
Further, there was a restitution order to pay the claimant (medical aid scheme member) R11 000 within two months.
MS Mhambi (PS 0118990/24885034)
Psychologist
Complaint
That you are guilty of unprofessional conduct and or conduct which when regard is had to your profession, is unprofessional in that on or about May 2021 until June 2021, you and/or your practice;
a) administered an assessment that was contra-indicated for the patient’s mental state;
b) communicated the results without due regard for the patient’s well-being.
Penalty
The Professional Conduct Committee found the Respondent guilty of unprofessional conduct and the Respondent is suspended for three years – wholly suspended for three years on the following conditions: that she undergoes training with specific focus on:
1. Axis (ii) borderline personality disorders;
2. Making appropriate clinical judgment with regard to assessment; and
3. Making appropriate clinical judgment with regard to communication of assessment results;
During the period of suspension, she is prohibited from treating borderline personality disorder cases; during the period of suspension she must submit quarterly reports to the education and training committee of the psychology board with regard to the issues raised above.
For proper implementation of the order the Registrar is directed to arrange the necessary with the performance assessment committee on receipt hereof.
Dr L Mokaedi (MP 0704245/230617- 0001)
Medical Practitioner
Complaint
That you are guilty of unprofessional conduct or conduct which when regard is had to your profession is unprofessional, in that on or about June 2023 in respect of your patient you did not act in accordance with the norms and standards of your profession in that you:
1. applied fraudulent billing practices in altering dates on which services were rendered; and/or
2. charged for services not rendered, and/or
3. performed termination of pregnancy in an unregistered facility.
Penalty
The Respondent pleaded guilty and was fined R10 000, payable in instalments of R2 500 starting from end of July 2024. Plus, a six-month suspension from practice, wholly suspended for one year on condition he is not again found guilty of a similar offence during the period of suspension.
See more from MedicalBrief archives:
HPCSA disciplinaries: negligence, fraud and sexual impropriety