People's Assembly

Wilson, Ms ER question

(1)For each year since 2018 in each province, (a) how does his department identify fraudulent claims, (b) what total (i) number of fraudulent claims have been paid out and (ii) amount of the specified money has been recouped and (c) what (i) are the top causes and/or reasons for medico-legal claims such as cerebral palsy and (ii) is the total number in each case; (2) whether any of the provinces are using manual tracking to track medico-legal claims; if so, why has an electronic tracking system not been implemented; (3) whether any of the provinces are using electronic tracking to track medico-legal claims; if so, why is manual tracking still used in some cases even though an electronic tracking system has been implemented?

Source Link in context Link

1. (a) In 2019, the National Department of Health appointed Service Providers to conduct forensic investigations. One of the responsibilities has been to identify any fraudulent claims. The reports of these investigations are the basis of the current SIU investigations in all the Provinces in line with the Proclamation.

The following table reflects the details in this regard:

Province	Number of fraudulent claims paid out	Amount of money recouped	Top causes and/or reasons for medico-legal claims	Total number in each case
Eastern Cape	Nil	Nil	Obstetrics & Gynae related	1135
			Orthopaedic,	92
			Surgical	42
			ICU related	46
			Other	399
Free State	Nill	Nill	Cerebral Palsy	132
			Surgical complications	53
			Gynae & Obstetrics	84
			Wrong diagnosis/ medication	63
Gauteng	Nill	Nill	Prolonged labour	18
			Brain damage	93
			Genetics	2
			Injury or impairment	66
			Multiple prior pregnancies	18
			Unwanted pregnancy	5
			Respiratory distress syndrome	1
			Prior damage to uterus	25
			Foreign object found in birth canal	9
			Bacterial infection	26
Limpopo	Nill	Nill	-	-
Kwazulu-Natal			-	-
Mpumalanga	Nill	Nill	Cerebral Palsy	613
			Orthopaedics	391
North West	-	-	-	-
Northern Cape	Nil	Nil	Cerebral Palsy	33
			Surgery	9
Western Cape	Nill	Nill	Obstetric other mishaps	20%
			General surgical	10%
			Trauma	5%
			Neurosurgery	5%
			Orthopaedics	5%
			Ophthalmology	5%
			Paediatrics	5%
			Anaesthetics	5%
			Other	10%

2. According to Provinces, they use both manual and electronic tracking systems. Most of the Provinces have their inhouse electronic system.

3. According to the Provinces, there are those that are using their own electronic system. These include Eastern Cape Mpumalanga, Limpopo and Western Cape. Kwazulu-Natal, Free State, Gauteng, Northern Cape and North West are using the Case Management System.

END.

Source Link in context Link

Correct this page

2023-w610 - 24 March 2023