BL Premium reports that the Council for Medical Schemes (CMS) has called for a swift, thorough investigation of allegations of billing fraud that an anonymous whistleblower made against private hospital group Mediclinic.

A person identifying as a former Mediclinic employee emailed medical schemes and journalists last week, alleging billing codes were manipulated to inflate claims submitted to medical schemes. The email describes alleged billing manipulation at six Mediclinic hospitals at which the whistleblower claims to have worked. The CMS said it was concerned about the allegations because inflated hospital claims could lead to members running out of funds prematurely and facing “unnecessary out of pocket and catastrophic health expenditures”. On Friday, the CMS called for “a comprehensive, unhindered and speedy investigation of these allegations by an objective and trusted authority.” It went on to indicate: “The investigation should not just aim to get the names of the responsible parties apprehended but should also ensure that the funds involved are quantified and returned to their rightful owners – the medical scheme members.” Mediclinic said it had appointed independent forensic expert Steven Powell of law firm ENSafrica to review the accusations and implicated hospitals. Mediclinic said it viewed the accusations in a serious light but was confident Powell’s investigation would confirm its billing processes were accurate and ethical. SA’s biggest medical scheme administrator Discovery Health said it had initiated its own investigation.

Read the full original of the report in the above regard by Tamar Kahn at BusinessLive (subscriber access only)

Read too, Fraud claims: Mediclinic names independent investigator, at Fin24

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