Anonymous Mediclinic whistle-blower guides auditors
A whistle-blower who has made explosive allegations that Mediclinic hospitals are guilty of irregular billing practices yesterday sent details of where auditors can start their investigations reports Daily Maverick.
As previously reported, a person who claims to be a former Mediclinic employee sent an email to more than 50 principal officers of some of SA's largest medical schemes.
It contained detailed information about what the person claimed to be their experience as a former clinical case manager at six Mediclinic hospitals in the Western Cape and Gauteng.
The person paints a picture of widespread manipulation of patients' clinical coding (which is used for medical scheme claims) at these hospitals to Mediclinic's alleged financial benefit.
Mediclinic said it has appointed Steven Powell, head of law firm ENSafrica's forensics practice, to head its independent audit into the matter.
The email, which DM has a copy of, details how the paper trail can be traced and which responsible parties should be interviewed and questioned.
The email sent by the whistle-blower on Monday seems to be a direct response to an invitation from Mediclinic’s chief executive, Greg van Wyk, for more details.
The response from the whistle-blower has been swift, with details of how the alleged fraud spans different job functions from reception to the billing department, case managers, confirmation clerks, credit controllers and patient admin managers.
The allegations have opened a can of worms and sparked investigations across the medical schemes industry.
Ryan Noach, the CEO of Discovery Health, says the medical scheme has already commenced an investigation into relevant claims from Mediclinic.
‘We have been assured by Mediclinic of a full and thorough investigation into the matter, including a comprehensive report back on the findings and outcomes of the independent review they have commissioned. Discovery Health Medical Scheme will determine what further action is required from these external and internal investigations,’ Noach said.
Business Day reports that the Council for Medical Schemes (CMS) has called for a swift, thorough investigation into the allegations.
Article disclaimer: While we have made every effort to ensure the accuracy of this article, it is not intended to provide final legal advice as facts and situations will differ from case to case, and therefore specific legal advice should be sought with a lawyer.
