Medico-legal mayhem: SIU exposes R4bn loss

The Special Investigating Unit (SIU) on Wednesday revealed that medico-legal claims in the public sector were ripping off citizens.

SIU head advocate Andy Mothibi said there was a web of collusion between unscrupulous lawyers, touts, and medical professionals defrauding the state and claimants.

He was giving feedback to Parliament’s Standing Committee on Public Accounts (Scopa) members on the medico-legal investigation.

According to reports presented by Mothibi, the unit’s investigation stopped the state from losing over R3.1 billion due to medico-legal corruption.

While the probing yielded significant outcomes, including averting potential losses of R3.104 billion, Mothibi told Parliament that the extremity of loss to the state could surpass R4 billion.

SIU exposes over 50 fraudulent schemes

95 investigations were done, of those, the medico-legal investigation identified 54 cases of actual fraudulent medico-legal claims.

The SIU made 51 referrals to the Legal Practice Council (LPC) and 45 to the Legal Practice Fidelity Fund.

It has been investigating medico-legal claims across provinces since 2022 and found that lawyers are defrauding both the state and their clients.

Nurses were also implicated in the scheme. It was found that they stole medical records to perpetuate the fraudulent activity.

‘Organised crime’

Mothibi presented a case study of an attorney in the Eastern Cape who received R373.8 million for 22 claims, but claimants remained poor due to lack of trust accounts.

“This has resulted in claimants remaining in appalling and impoverished [conditions]despite receiving compensation from the department through their lawyers for medical negligence claims,” said Mothibi.

Despite claims being made in their names, some children still live in poverty and appalling conditions.

Mothibi described the situation as “organised crime” and recommended a total overhaul of the claims process.

“Many of these claimants are unemployed and rely on social grants from the South African Social Security Agency (Sassa) for their livelihood.

“Some households are constrained to a single-room “rondavel” without appropriate railing or ramps to assist disabled children, resulting in inadequate living conditions and insufficient caregiving.”

He also raised concerns about the state attorney’s office, which processes these claims, saying it requires improvement and monitoring.

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Some of the recommended SIU methods included the following:

• Electronic records keeping and archiving systems
• Public Health Institution Registers
• Maternity Ward Daily Incident Reports
• Ambulance Registers
• Clinic cards for expecting mothers
• Raising the “National Public Healthcare defense”
• Employment of qualified medical experts

Mothibi shared confidence that these bodies will take appropriate action against the lawyers involved.