The Bloemfontein Magistrate’s Court in Free State has convicted and sentenced a 48-year-old mother, after she defrauded the Government Employees Medical Scheme (Gems) of more than R400,000.
Mamello Kate Khabo was last week found guilty of medical aid fraud and sentenced by the court.
Free State spokesperson for the Directorate for Priority Crime Investigation, also known as the Hawks, Lieutenant Colonel Zweli Mohobeleli said Khabo brought her daughter who was not on the Gems medical aid, to a hospital and the minor was admitted.
The sick child’s sister, Khabo’s other child, was the one with Gems medical aid cover. The sick child later died in hospital.
“The accused defrauded Government Employees Medical Scheme over R400 000 in medical aid claims. In August 2022, the accused (Khabo) admitted her daughter to Busamed private hospital in Bloemfontein. The patient was later transferred to MediClinic where she sadly passed away,” said Mohobeleli.
“When it was time to register her daughter's death and be issued a certificate, she was left with no choice but to confess that she had admitted her deceased daughter under the name of her surviving daughter, who is a beneficiary of Gems.”
Mohobeleli said Hawks detectives collected evidence of the fraud, enough to convince the court to issue a warrant of arrest against the grieving mother.
On November 12 last year, Khabo was arrested.
Khabo was sentenced to four years imprisonment, wholly suspended for five years on condition that she is not convicted of a similar offence during the period of suspension.
At the time, the Hawks said the medical practitioner pleaded guilty to the charges before she was sentenced.
“She pleaded guilty and was sentenced to a fine of R120,000 or five years imprisonment. She was further declared unfit to possess a firearm,” said Limpopo spokesperson for the Hawks, Warrant Officer Lethunya Mmuroa.
In 2021, Platinum Health Medical Scheme (PHMS) noticed a spike in claims for the period from February 2, 2020 to December 18, 2020.
Mmuroa said an internal investigation was conducted, and it was established that the claims were submitted by a healthcare practitioner, Homu.
“During the above-mentioned period, the PHMS received more complaints from their members regarding claims submitted by the health care practitioner without their knowledge or concerns as they did not receive any health care services,” said Mmuroa.
“During analysis of the claims, the medical scheme found more anomalies such as claims for multiple beneficiaries and multiple referring practices.”
It was further discovered that Homu had not rendered any services to the medical scheme members or their dependants as she had claimed, based on falsified information.