At least 19 accused people and entities have appeared before the Nelspruit District Court after they were arrested and charged by the Hawks’ Nelspruit-based Serious Commercial Crime Investigation unit for fraud and contravention of the Medical Scheme Act.
Hawks spokesperson in Mpumalanga, Captain Dineo Lucy Sekgotodi said the 16 accused people are Nkosazane Nyathi, 40, Nelile Shabangu, 34, Brenda Nzima, 38, Nokuthula Ubisi, 40, Thabo Ndlozi, 38, Muideen Moshood, 56, Lucky Lubisi, 37, Nomvula Maduna, 61, Sipho Mkhatywa, 50, Nomvula Tolla, 42, Prisca Mokoena, 40, Sarah Nyambi, 53, Sharon Williamson, 38, Veronica Keis, 52, Vusi Mkhumbane, 66, Victor Mpofu, 42.
They are charged alongside three entities – Valencia, Nala, and Buffelspruit pharmacies.
The 19 accused appeared before the Nelspruit District Court on Monday.
“It is alleged that members of medical scheme (the Government Employees Medical Scheme Gems) colluded with pharmacies to defraud the medical scheme by means of claiming for services that were not rendered by the pharmacies in exchange for cash or purchasing items that are not covered by the medical scheme,” said Sekgotodi.
“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,” Sekgotodi said.
It is further alleged that the Gems members received non-medical goods in lieu of the false claims submissions.
The government employees’ medicals scheme lost R2.3 million in the fraudulent scheme.
The medical scheme Gems conducted internal investigations to determine the veracity of the allegations of false claim submissions.
“During investigation, it was discovered that members of the medical scheme colluded with the pharmacy directors, Lucky Velaphi Lubisi, Thabo Ndlozi, Nelile Shabangu and Mukden Mashood to make misrepresentations to Gems, well knowing that what they were doing was not in line with the prescripts regulating pharmacies as prescribed in the regulations.
“The complaint was reported to the Hawks in 2020, whereby investigation was conducted hence the arrests,” said Sekgotodi.
Fourteen accused, including three entities were released on R1 000 bail each.
Four pharmacists were released on R5 000 bail each and a pensioner was released on warning, with conditions that they should not commit any similar offence.
The accused were also warned not to interfere with witnesses or the investigation, and that they should also appear in court all the times when required.
-IOL
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