An independent investigation has cleared Mediclinic of intentionally manipulating billing or coding to save the hospital group money.

A News24 report notes that Steven Powell, head of law firm ENSafrica's forensics practice, found no evidence of an intentional manipulation.

However, he did find incidents involving mistakes or unintended errors, but they were ‘random and miniscule’, and formed part of the ‘normal cause of business’.

One previous billing problem had led to a disciplinary process for an employee.

Said Powell: ‘The processes we investigated are complex, and we found no evidence of an intentional practice of manipulating billing or coding at a group or hospital level’.

The probe began after a whistleblower, who claimed to be a former Mediclinic employee, sent an email to more than 50 principal officers of some of SA's most prominent medical schemes last year. It contained detailed information about what the person claimed to be their experience as a former clinical case manager at six Mediclinic hospitals.

In addition, a former Mediclinic employee contacted News24 with similar claims at two hospitals.

Powell said the probe focused on the six hospitals, and then six other hospitals in the group were randomly selected without forewarning.

Powell said that the incident referred to by the whistleblower occurred in 2011 when the Alternative Reimbursement Agreement model was initially implemented.

He said that that particular hospital was also a recent addition to the group.

‘They didn't adapt well to the changes, and they made mistakes. It was investigated properly at the time, and the finding was that it was unfortunate. But the mistakes were addressed,’ said Powell.

Full Fin24 report

See also full Business Day report