Question NW610 to the Minister of Health
24 March 2023 - NW610
Wilson, Ms ER to ask the Minister of Health
(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?
Reply:
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.