Fund loses R400m a year through false claims

Mfundekelwa Mkhulisi

Mfundekelwa Mkhulisi

One of the country's top medical aid groups, Bonitas Medical Fund, loses more than R400 million a year through false claims by unscrupulous doctors.

Bonitas principal executive officer Bafana Nkosi made this claim yesterday after a Sunday newspaper reported that two doctors were arrested for defrauding the medical aid fund.

Nkosi said Bonitas would now closely scrutinise claims to curb this escalating practice.

"There is a new computer programme which can tell which tooth you took out, so that when you try to claim for it again, we will be able to find out," he said.

Nkosi said Bonitas would also use the expertise of forensic investigators to bring fraudsters to book as was the case with two exposed health practitioners.

Dr Andrew Atuhaire, based in Richards Bay, KwaZulu-Natal, allegedly made fraudulent claims in excess of R10million from Bonitas for consultations that never took place.

He was arrested last week for fraud and will appear in the Richards Bay magistrates' court for a bail application today. Atuhaire, a Ghanaian national who has South African citizenship, has been practising in South Africa for more than five years.

"There are more groceries than medicine in his surgery," said an investigating officer.

"People would come and ask for money or baby milk. Atuhaire would then claim as if they were patients," he said.

Atuhaire is alleged to own a fleet of cars, townhouses and a guesthouse. In statements in the charge sheet against Atuhaire, "patients" denied ever having consulted him. Others said they had received cash from the doctor on several occasions.

A weekend newspaper reported that Bonitas became suspicious when Atuhaire made excessive claims between 2003 and 2004.

Meanwhile, the trial of Dr Ismail Mall Mohamed, who owns several pharmacies in Pinetown and Pietermaritzburg, begins in the Durban high court today.

Mohamed, who teaches pharmacology at the University of KwaZulu-Natal, also faces fraud charges for allegedly defrauding medical aid schemes.