Overdue patient fees have climbed to a staggering R4.6bn at Gauteng provincial hospitals and, in the case of a private hospital, led to a fight for payment all the way up to the Supreme Court of Appeal which this week ruled in its favour.
MedicalBrief writes that in the payment dispute between Benoni's Sunshine Hospital and the Road Accident Fund (RAF) – among the key non-paying culprits at state hospitals too – the court ordered the fund to pay more than R92m within seven days, upholding a High Court appeal (see story below).
In the case of provincial hospitals, R2.4bn is owed by individual patients, South African citizens and foreign nationals, but the rest comprises outstanding payments from medical aids and government departments, like the RAF, the Department of Justice, the SAPS, Correctional Services and other provinces.
The RAF owes R1.6bn for the treatment of crash victims in provincial hospitals, according to the Sowetan, while the Department of Justice owes R94m.
The department said when a motor vehicle case is seen in a hospital or any health facility, the hospitals are expected to claim for the services provided to the patients.
“RAF receives funding or a levy, of which part of its component is payment of medical claims as a result of liability or service rendered. So, we billed for these services, and RAF didn’t pay. These are historical claims.”
Other debtors include:
• SAPS: R36m;
• Correctional services: R53m;
• Compensation Fund: R17m; and
• North West Province: R22m.
Public healthcare services are not entirely free, added the department.
“The system operates under the Uniform Patient Fee Schedule (UPFS), which provides a structured, income-based framework for billing services. And while primary healthcare services are free, hospital-based services are subsidised depending on a patient’s classification.
“Debt arises when patients liable for payment don’t settle their accounts, when medical schemes delay or dispute payments, and where patients are untraceable. In emergency and high-risk cases, treatment is provided without delay, regardless of a patient’s ability to pay,” it said.
This comes after last year’s 4.4% general patient fee increase by the department, which included a 30% hike in emergency medical services (EMS) standby fees.
The province is now proposing another round of tariff adjustments for 2026/27 under the UPFS, with the gazette out for public comment.
As far as self-paying patient fees are concerned, most of the debt comes from maternity services.
“This is generally concentrated in high-volume regional and tertiary hospitals, where demand for specialised and emergency care is highest. Maternity services are a significant contributor, driven by high patient volumes, emergency presentations and cases where patients may not be traceable after receiving care.”
Debt collection
Spokesperson Kealeboga Mohajane said debt collection agencies have now been appointed and internal systems are being bolstered, while targeted interventions have also been introduced to strengthen medical aid claims management.
“This includes tightening billing controls, improving claims submission processes and addressing longstanding administrative gaps that have historically resulted in delayed or disputed payments by medical schemes.”
News24 reports that as part of these efforts, the department has strengthened revenue collection capacity through participation in the Transversal Contract RT27-2024 for the provision of debt collection services to the state, managed by National Treasury for the period of 1 April 2024 to 31 March 2029.
“Since the appointment of five debt collectors in June 2025, the Department had collected R28.8m by 28 February 2026, with a particular focus on self-paying patients, including foreign nationals," Mohajane said
“Upfront payment protocols are also being enforced for patients who do not qualify for free healthcare services, which will limit the accumulation of new debt.”
Additionally, the department is stepping up measures to improve patient identification and verification systems, which include integration with national databases to enhance traceability and support debt recovery efforts.
In the SCA case, the RAF has been ordered to pay Sunshine Hospital more than R92m within seven days, upholding an appeal against a High Court judgment which dismissed its application to enforce the payment of a civil judgment granted against it, reports Moneyweb.
The civil claims by Newnet Property (Pty) Ltd – trading as Sunshine Hospital – were dismissed on the basis of res judicata, a well-established legal principle that where a court has given a final judgment in a matter, any subsequent litigation between the same parties in respect of the same subject matter and based on the same cause of action is not permitted.
On Tuesday, SCA Judge Fayeeza Kathree-Setiloane, with Judges Pieter Meyer and Daisy Molefe concurring, upheld the appeal with costs and set aside and replaced the order.
‘Make this payment’
Under the order, the RAF has to pay Newnet/Sunshine Hospital R92 085 106.36 within a week, and provide Newnet with an updated ‘Requested Not Yet Paid’ (RNYP) list, also within seven days, as well as an updated RNYP list to Newnet every 14 days after compliance with this part of the order.
RNYP claims are for invoices that have already been audited and approved by the RAF.
‘Make these payments too’
The fund was also ordered to adjudicate all accounts issued to it by Newnet within 120 days of receipt of these accounts, and directed to:
• Make payment to Newnet of R158 890.70 within 30 days of the order (the amount due to it on the May 2023 RNYP list); and
• Thereafter to pay Newnet all amounts due to it as per the current RNYP list within 30 days of the adjudicated account appearing on the RNYP list.
The SCA further directed and ordered RAF acting CEO Radikwena Phora to ensure that the RAF complies with its order.
Patients referred
When Newnet instituted the application in the High Court in June 2024, it operated as a hospital and treated patients who were injured in car accidents – most of whom were referred or transferred to Sunshine for treatment by either the RAF or state hospitals that were unable to provide them with the necessary medical care.
Under an agreement, Newnet invoiced the RAF for payment of services rendered by it and those provided by its associate medical practitioners.
By March 2020, the RAF had stopped paying it for services rendered to motor vehicle accident patients, leading to extensive legal proceedings against the fund.
The RAF has only paid Newnet R336 316 021.13, with a balance of R92 085 106.36 remaining unpaid. This led to Newnet instituting the June 2024 application, which included applying for former RAF CEO Collins Letsoalo to be directed to ensure the fund complied with the other aspects of its application.
The fund obstructed payment of Newnet’s long overdue RNYP claims by delaying settlement and also withholding the RNYP list from Newnet.
It has not sent an updated RNYP list to Newnet since May 2023.
According to the last RNYP list furnished by the RAF to Newnet, the fund owed Newnet about R380m, of which R158 890 967.70 remains unpaid.
Kathree-Setiloane said that in April 2023, because of no payments from the RAF, Newnet was forced to close the hospital.
Since the second quarter of 2024, Newnet has unsuccessfully attempted to execute against fuel and road accident levy funds purportedly owing to the RAF by the relevant entities – including the South African Revenue Service (SARS), the South African Reserve Bank, National Treasury and the Department of Transport.
The relief sought by Newnet is, among others, for the civil enforcement of the judgment debt against the RAF and does not seek to enforce a civil claim for payment of debt by asking for a new judgment or order for payment of the R92m owing but rather seeks to enforce payment of judgment debts and compliance with court orders.
She said the RAF’s deliberate refusal not to comply with the court orders constituted a breach of its statutory obligations, and ruled that Newnet was entitled to seek an order compelling the RAF CEO to ensure the relief sought was complied with.
Newnet is also entitled to receive updated RNYP lists from the RAF allowing it to keep track of what payments are due to it, and that the RAF is adjudicating its claims.
She disagreed with an RAF contention the appeal is moot because Newnet has ceased to operate.
Newnet had suspended operation of the hospital in May 2025 but remains the owner of the hospital: it has not been provisionally wound-up and no pending legal process or threat exists.
Kathree-Setiloane said the shareholders and board of Newnet will seriously consider reopening the hospital upon payment by the RAF.
“Thus as things stand, the closure of the hospital is not an impediment to Newnet succeeding in the appeal,” she said.
Moneyweb article – RAF ordered to pay Sunshine Hospital R92m within seven days (Open access)
TimesLIVE – Gauteng health department seeks R4.6bn in unpaid patient bills
News24 – Gauteng health dept faces mammoth R4.6bn debt crisis, mostly from self-paying patients
Sowetan – RAF owes R1.6bn for treatment provided to crash victims, says Gauteng health
See more from MedicalBrief archives:
SCA dismisses RAF appeal over hospital claims rulings
Hospital forced to close after R300m RAF debt