Whether in the United States or halfway around the world, the fight against workers compensation fraud is taken seriously.
Recently, South Africa’s Department of Labor’s Compensation Fund reported completing 86 out of 142 cases of fraud and corruption within four months, leading to the arrest and conviction of employees and medical health care providers.
The Fund recently briefed the Portfolio Committee on Labor on its preliminary annual performance, strategic plan for 2013 to 2018 as well as 2013/14 annual performance plan.
House Arrest, Suspension for Defendants
Shadrack Mkhonto, the Fund’s commissioner, said the drive against corruption and fraud has resulted among others, in two medical health care providers being convicted and sentenced to three years’ house arrest and five years suspension for both. The duo was ordered to pay back R2.1 million and R455,212 with 15 percent interest.
He said another four medical health care providers were currently on trial for defrauding the Fund to the value of R1,359,876.
Mkhonto said seven former employees of the Fund were also on trial for colluding with health care providers. Also, two health care providers were being disciplined by the Health Professions Council of South Africa.
He said as part of the fraud prevention strategy, the Fund was raising awareness to staff about the dangers this posed to service delivery.
Effort Made to Reduce Claims
Turning to strategies to reduce the claims backlog, the Fund said it aimed to finalize 100 percent of medical claims within 30 days of receiving an invoice by 2016.
“Equally, we want to be able to provide medical advice on all medical claims within 24 hours by 2016. We also intend developing a rehabilitation and reintegration policy framework and participate in consultative processes by 2014,’’ Mkhonto added.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
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