- The Special Investigating Unit (SIU) has saved the Department of Health R3 billion by investigating fraudulent medico-legal claims.
- These investigations revealed widespread corruption involving lawyers, hospital staff, and patients.
- The Western Cape’s proactive measures have largely protected it from these fraudulent activities.
The Western Cape Department of Health and Wellness has welcomed the Special Investigation Unit (SIU) investigation into fraudulent, criminal and corrupt medico-legal claims across the country.
The SIU has to date saved the Department of Health R3 billion in fraudulent medical negligence claims.
This follows a directive from President Cyril Ramaphosa in 2022, officially gazetted in July 2022 under the Special Investigating Units and Special Tribunals Act.
Known as “the State’s preferred and trusted anti-corruption, forensic investigation and litigation agency”, the SIU was called on by Ramaphosa to investigate – among other matters – improper or unlawful conduct by officials, staff and institutions, unlawful expenditure, intentional or negligent loss of public funds and unlawful or improper conduct by claimants or applications citing medical negligence.
Explosion in cases
Cases surrounding these medico-legal claims were investigated also led to a probe of improper conduct from lawyers and patients, but also staff, officials and general institutions.
The period in question was from 1 January 2013 and the date of the Government Gazette’s publication of the proclamation (page 24, No 47055, Government Gazette 22 July 2022).
SIU head advocate Andy Mothibi and National Health Minister Aaron Motsoaledi held a joint media briefing in Pretoria on Saturday 24 August on the findings of their on-going investigation into fraudulent claims submitted by lawyers and institutions, among others.
“Around 2015, the health sector experienced an explosion of medical-practice litigation cases directed against health institutions as well as individual medical practitioners in both the public and private practice. This explosion happens to have coincided with the Road Accident Fund (RAF) strengthening its systems. It is common cause that the RAF had been hollowed out by a multiplicity of claims that brought it down to its knees.
“In the aftermath, legal practitioners who used to litigate against the RAF seem to have migrated en masse to the Healthcare Sector. In response, the Department of Health convened a medico-legal claim Summit in 2015.”
In the days following the briefing, the RAF said it would assist the department and SIU as the findings are “a vindication of what the Fund has been saying all along that lawyers have been at the forefront of grand scale looting of state coffers.”
RAF chief executive officer Collins Letsoalo said: “Defrauding government departments and entities robs South Africans, claimants and their families of their livelihood. It is profoundly disappointing that some hospital patients and accident survivors encounter thieves disguised as professionals.”
From the 2020-’21 to 2022-’23 the RAF, through its internal Forensic Investigation Department, successfully stopped fraudulent claims to the value of R2,6 billion.
Motsoaledi said despite the summit the department continued to note several claims that were completely out of sync and made no sense at all. “There were claims that were evidently fraudulent,” he said. “Just as an example, a claim was submitted in which the claimant demanded R70 million for a supposedly botched circumcision by a doctor in a hospital in Limpopo Province. On investigation of this claim, it was found out that no such circumcision was ever performed. It was found that the patient was actually treated for a very serious genital infection. The hospital actually saved his life,” he says.
Cerebral palsy
By 2017, the SIU honed its investigation in on the Eastern Cape where medico-legal claims amounted to R15,9 billion while in Gauteng the figure was R21,2 billion. These were the highest in the country at the time.
According to the SIU, most of the claims were targeting cerebral palsy, a condition in which babies develop some form of brain damage due to depravation of oxygen during the process of birth.
“While it is recognised that cerebral palsy is a very debilitating and unfortunate occurrence to come from the healthcare system, it is a matter of very serious concern that it is abused by legal practitioners, due to sheer greed. The level of abuse was such that the SIU found that some of the claims were made on behalf of patients without their knowledge,” says Mothibi.
The SIU also uncovered scams of lawyers and firm workers misrepresenting themselves as social workers to elderly people taking care of their grandchildren, where they were conned into signing over Power of Attorney to sue while being under the impression they were signing SASSA forms for child support grants.
Johannesburg-based Nonxuba Attorneys Incorporated is one of the identified players in these fraudulent claims, with most originating in the Eastern Cape.
“We are able to name the firm today because they have already been charged in a court of law,” says Motsoaledi.
In a period from 2012 to 2017, this law firm submitted 44 medico-legal claims to the tune of R497 million against the Eastern Cape Department of Health, mostly for children with cerebral palsy.
“Claims submitted by Nonxuba for each of nine children for whom claims were submitted were identical, in that he demanded R15 million each,” continues Motsoaledi. “This was clearly suspicious and also indicated a lot of cut-and-paste on the part of this legal firm.”
In the Western Cape, 409 medico-legal claims to the value of more than R2,8 billion had been submitted between 2015-’16 and 2020-’21 financial years.
Undermining integrity
To date more than R270 million in claims have been paid; preliminary assessment data on how many cases are currently under investigation in the province is unspecified. “In the Western Cape, the SIU identified 33 fraudulent birth injury claims in the contingency liability register to the value of approximately R409 million,” said Mothibi.
“These cases include allegations of fraudulent medical negligence claims submitted by Nonxuba Incorporated Attorneys on behalf of various patients. Fortunately, nothing has been paid and the matters are before the courti.
Mireille Wenger, provincial Minister of Health and Wellness, said the department welcomed the SIU investigation.
“These fraudulent medico-legal claims undermine the integrity of our health system, diverting resources away from those needing medical care or genuinely needing recourse after suffering harm. While medico-legal claims are crucial for ensuring accountability and maintaining a robust health system, it is unacceptable for individuals to exploit this process. Those responsible for such fraud are not only committing a crime but are also robbing citizens who have been truly wronged of the justice and support they deserve.
“Through proactive measures from our medico-legal team, the Western Cape has been able to largely avoid becoming victims of these criminal activities. We have been and will continue working with the SIU to investigate medico-legal claims and establish their veracity to ensure that resources only reach those who have a bona fide case.”
