KEY POINTS
- A woman obtained false medical credentials to have her uninsured daughter admitted and inflicted R400,000 worth of fraudulent payments on the system.
- The investigation exposed the crime when the child lost his life which compelled the mother to reveal everything.
- The court issued a four-year prison sentence which all subsequent terms became ineffective following five years of suspension.
A 48-year-old mother named Mamello Kate Khabo received jail time for defrauding the Government Employees Medical Scheme (Gems) out of R400,000 by taking her sick daughter to hospital under the medical aid credentials of a different daughter.
The Bloemfontein Magistrate’s Court convicted Khabo for medical aid fraud by giving her a four-year suspended sentence which required her to remain crime-free for five consecutive years.
Hawks spokesperson Lieutenant Colonel Zweli Mohobeleli reported that Khabo put her uninsured daughter into Busamed Private Hospital in Bloemfontein through the medical aid information of her other child in August 2022. The girl was moved from Busamed Private Hospital to MediClinic after which she died fatally.
When Khabo attempted the death registration for her deceased daughter she became obliged to expose the falsified hospital admission records. The Hawks investigators compiled enough evidence to prosecute Khabo for her criminal acts that resulted in her November 12, 2023 arrest.
Medical aid fraud cases on the rise
The fraudulent medical practices utilized by Khabo belong to an upward trend of medical aid fraud occurrences across South Africa.
Furthermore, in 2021 Penelope Homu a Limpopo psychologist received a conviction for fraud through submitting false health insurance claims to Platinum Health Medical Scheme (PHMS).
The defendant Homu admitted her guilt which resulted in a court choice between a R120,000 fine and five years in prison. Income Claims submitted by this psychologist for non-existent treatments triggered multiple false overpayments detected by PHMS throughout the period between February and December 2020.
The authorities maintain strict enforcement against false medical aid activities because they will strictly enforce severe legal penalties on offenders.
