Byline: Thendo Funyufunyu
Tuesday, 07 March 2023
Nineteen (19) people allegedly accused of defrauding an amount worth R2.3 million appeared before the Nelspruit District Court on Monday, 6 March 2023 after they were arrested by the Hawks Nelspruit based Serious Commercial Crime Investigation for Fraud and Contravention of Medical Scheme Act 131 of 1998.
Nkosazane Nyathi (40)F, Nelile Shabangu (34)F, Brenda Nzima(38)F, Nokuthula Ubisi (40)F, Thabo Ndlozi((38)M, Muideen Moshood (56)M, Lucky Lubisi (37)M, Nomvula Maduna (61)F, Sipho Mkhatywa (50)M, Nomvula Tolla (42)F, Prisca Mokoena(40) F, Sarah Nyambi(53)F, Sharon Williamson (38)F, Veronica Keis (52) F, Vusi Mkhumbane (66)M, Victor Mpofu (42) and three entities, Valencia, Nala and Buffelspruit Pharmacies all they appeared in court for the fraud allegation.
Members of the Medical Scheme are accused of conspiring with pharmacies to defraud the Medical Scheme by making claims for services that the pharmacies did not provide in exchange for payment or by making purchases of commodities that were not covered by the Medical Scheme.
The allegations relate to the submissions of claims by Valencia, Nala, and Buffelspruit pharmacies to GEMS for services or goods that were not supplied or rendered to the members.
It is further alleged that GEMS`s members received non-medical goods in lieu of the false claims submissions.
GEMS conducted internal investigations to ascertain the truthfulness of the allegations of false claims submitted. Investigations revealed that members of the medical scheme conspired with the pharmacy directors, Lucky Velaphi Lubisi, Thabo Ndlozi, Nelile Shabangu, and Mukden Mashood, to falsely represent GEMS, knowing that their actions were against the Regulations’ requirements governing pharmacies.
In 2020, the Hawks received a complaint; after an investigation, an arrest was made.
Fourteen accused, including three entities, were released on R1000 bail each, four pharmacists released on R5000 bail each and a pensioner was released on warning with conditions that they should not commit any similar offence to the one they are out on bail for. They should not interfere with witnesses or the investigation.
They should also appear in court all the time when they are required.
It is reported that the case was postponed to 28 March 2023 for further investigation. More arrests are imminent.
The Provincial Head of the Hawks, Major General Nico Gerber, applauded the team for the stunning work which included the National Prosecution Authority.
He also issued a warning against fraud and corruption to all government workers.
“As the Hawks, we are committed to serving the inhabitants of Mpumalanga and the country as a whole. Members need to report corrupt service providers and not get lured into schemes that will land them in trouble and risk their future,” said Major General Gerber.