Suspected medical aid scheme fraudsters released on bail

A total of 19 suspects appeared at the Nelspruit district court on Monday for fraud after they were accused of defrauding a medical aid scheme.

The fourteen accused including three entities were released on R1 000 bail each while four pharmacists were set free on R5 000 bail each. A pensioner was let go on warning.

They were all released on condition that they do not commit a similar offence and the case was postponed to March 28 for further investigation. More arrests are imminent. 

It is alleged that the accused colluded with pharmacies to defraud a medical aid scheme by claiming services not rendered to members of the medical aid scheme.

In exchange, the accused received cash or purchased items not covered by the scheme.

Police spokesperson Captain Dineo Sekgotodi said the allegations relate to submission of claims by Valencia, Nala and Buffelspruit pharmacies to Government Employee Medical Scheme (GEMS) for services or goods not supplied or rendered to the members.

“It is further alleged that GEMS members received non-medical goods in lieu of the false claim submissions,” Sekgotodi said.

GEMS conducted internal investigations to determine the veracity of the allegations of false claim submissions.

“During the investigation, it was discovered that members of the medical scheme colluded with pharmacy directors – Lucky Velaphi Lubisi, Thabo Ndlozi, Nelile Shabangu and Mukden Mashood – to make misrepresentations to GEMS.”

According to Sekgotodi, this they did knowing what they were doing was not in line with the prescripts regulating pharmacies as prescribed in the regulations. 

A complaint, which was reported to the Hawks in 2020, was followed by an investigation that resulted in the arrest of the suspects.

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