Thursday, 13 June, 2024
HomeMedico-LegalPharmacist sues ‘bullying’ medical schemes and CMS for 'discrimination'

Pharmacist sues ‘bullying’ medical schemes and CMS for 'discrimination'

An independent black pharmacist is taking various medical schemes and the Council for Medical Schemes to the Equality Court, accusing them of discrimination and trumped up charges that resulted in him losing his businesses.

Alfred Mokoditoa, owner of Amalig Pharmacies, said his contracts were terminated after irregular audits and fictitious charges that led to the Government Employment Medical Scheme (Gems) and others blacklisting his pharmacies, and his having to close four of them in 2011.

“Corruption at the CMS has destroyed my pharmacies’ businesses and I am seeking an order for R228 600 000 for harassment, pain, suffering, emotional distress and racial profiling,” Mokoditoa said.

The pharmacies were small enterprises in Atteridgeville and Pretoria, which he said were blacklisted while he was questioned, arrested and appeared in court.

He said the the schemes orchestrated trumped-up charges against him with the aim of destroying the successful black practices and allowing “white corporate-owned pharmacies” to flourish, reports the Sunday Tribune.

Mokoditoa said these “lawless” acts were protected by the CMS, which was supposed to ensure all entities conducting the business of medical schemes complied with the Medical Scheme Act.

In his court papers, the respondents are cited as CMS, Discovery Health Medical Scheme, Bonitas, Medscheme, Hosmed, the SAPS medical scheme (Polmed) and Gems. He also accused them of using “spy tapes”.

The matter is expected to be heard on 18 August.

He said between 2004 and 2005, he learnt that the owner of Blackrock, one of his pharmacies, was asked to contact the forensic unit of Discovery Health Medical Scheme regarding an investigation. He was told they were in possession of video footage obtained by “one of the spies” working for him.

Blackrock had allegedly been submitting fraudulent claims for non-medicinal products like baby formula, baby nappies, toothpaste and washing powder.

“I was given a choice to either come up with a settlement and pay the scheme the money it had lost or suffer for three years because of the claims against Blackrock – otherwise the scheme would report the owner of Blackrock to the SAPS and South African Pharmacy Council.”

Mokoditoa said he rejected the proposal, and that he needed to “get the other side of the story” from the “responsible pharmacist of Blackrock” but was told there would be negative consequences for non-co-operation.

He said he told Discovery to go ahead and report the matter to the relevant authorities, and in the interim, he had reported the matter to the CMS.

Discovery later threatened him with court action and forced him to sign an acknowledgment of debt (AOD) of R30 000 for Blackrock, he added.

The AOD, he said, was not part of the medical scheme contract between Blackrock and Discovery, and was unlawful.

Mokoditoa said other schemes followed and used the same modus operandi, and Bonitas stopped providing benefits due to Blackrock. A letter from Medscheme also followed, indicating that Blackrock was involved in irregular and fraudulent activities. The administrator suspended benefits to Blackrock.

Hosmed followed suit in 2007. This was after Mokoditoa realised Hosmed’s payments did not reflect on his pharmacies’ bank statements. He said he never received any notification to that effect.

Mokoditoa said his pharmacy group also rendered health services for more than R1m to Polmed members – that the claims were received, accepted and processed and authorisation numbers issued. However, instead of effecting benefits, the scheme alleged fraud on all claims submitted and opened a criminal case against Mokoditoa. The benefits were withheld.

Mokoditoa said he then lodged a complaint with the Special Investigating Unit (SIU) against four senior managers of CMS.

The four had failed to enforce compliance with Section 59(2) of the Medical Schemes Act (MSA) against Medscheme and Hosmed, he added. He said another manager issued a fake ruling of the CMS Appeal Board in favour of Polmed, and that the four were dismissed by CMS on 13 December 2019, after the SIU investigation.

Last week, CMS spokesperson Stephen Monamodi said the regulator was aware of the application and had filed its responses.

Hosmed, Discovery, Bonitas were looking into the case, Gems said the issue was sub judice, and Medscheme, which had filed its responses, believed there was no merit to the case.

Sunday Tribune PressReader article – Black pharmacist sues medical schemes for R200m (Open access)


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