In another twist involving the public protector’s office‚ the Minister of Co-operative Governance an.
Several senior "fat cat" doctors employed by the KwaZulu-Natal health department have been fingered in a multi-million rand scheme thriving at the expense of taxpayers.
It is alleged that the culprits who own private practices have been exploiting the loopholes in the system to con and cripple health service delivery to the poor in the province.
It has cost the province's department of health billions over the past few years.
A high level investigation is under way and those responsible could face time in jail.
The department's expenditure for the 2008-09 financial year amounted to R14,959billion, exceeding the R13,925billion budget for the financial year by R1,034billion.
The department overspent by R730million in compensation to employees and R637million in goods and services.
The doctors employed by the state have their own private practices and links with private hospitals.
The state-employed doctors use the system called "remuneration outside working hours" to claim for extra hours. The worst transgressors are in the greater Durban and Pietermaritzburg areas - two of the biggest state hospital service areas in the region.
Insiders within the provincial health department said that when patients go to the respective doctors for medical checkups the doctors use their authority to refer them to the state facilities.
"Later the same patients are transferred by the same doctors to private hospitals.
"There has been an increase in the number of state patients who are referred to private hospitals in recent years," said a senior member of the department.
He said the state is then billed by the private hospitals as well as the doctors who have been loading up the extra hours at the private hospitals while "following up on their patients".
"The department has no alternative but to cough up the monies owed," he said.
Another senior health official who did not want her name published said a forum of hospital managers had raised the issue with the department several times.
"These things happen on a daily basis but no one talks about it. Doctors are entrepreneurs and they have identified an opportunity to make more money.
"Patients are easily transferred from a state hospital to a private hospital, especially when the doctor suggests that they need special care or an operation, when there are insufficient beds at the state's intensive care or theatre."
Provincial health spokesman Leon Mbangwa said the department is aware of such practices.
He said new policies have been introduced to curb the abuse.
"We are confident that the practice that compels public servants to declare all their interests will help us catch those transferring patients to private health sectors where they have an interest. Any government employee who wants to conduct remunerative work outside of the public service must get permission."
"A decision to transfer patients should be approved by the chief officer and the head of department at the province's health department," he said.
He acknowledged that the system was being manipulated by "people in the public service to make profit, and disregard for legal and policy prescripts".