Doctor pair arrested for medical aid fraud

Doctors Mahendra Pramchand and his ex-wife Anez Awath-Behari in a picture taken in January 2011. Picture: Marilyn Bernard

Doctors Mahendra Pramchand and his ex-wife Anez Awath-Behari in a picture taken in January 2011. Picture: Marilyn Bernard

Published Apr 24, 2012

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Two Durban doctors have been charged with medical-aid fraud amounting to R3.5 million for submitting false claims.

Doctors Anez Awath-Behari and her ex-husband Mahendra Pramchand were arrested on Monday by officers of the commercial crime unit.

They appeared in the Durban Commercial Crime Court and were granted bail of R60 000 each.

They have been charged with multiple counts of fraud and of contravening the Medical Schemes Act.

According to the charge sheet, Behari is a representative of the Prydon Clinic, an alcohol and drug-abuse treatment centre in Phoenix.

It is alleged that Behari and Pramchand would “admit” patients, some of whom were police officers, to the clinic for substance-abuse treatment or depression for a period of 21 days.

The clinic would then submit account statements to Polmed, a medical aid for the police, and Bonitas medical-aid scheme.

 

However, the State alleges that the patients were never admitted to the clinic and no services were rendered. The claims were made for “hospitalisations” during 2007 and 2008.

According to the charge sheet, the alleged fraudulent activities were picked up after Sam Chauke, manager of Qualisa Health Care, which is a division of Polmed’s admini-strator body, Medical Health Corporation, received information from the Fraud Hotline that between June 2007 and January 2008, a member of Polmed had submitted claims for being treated at the Prydon Clinic, whereas in fact she was at work.

Qualisa did a random validation of claims of a few members of the Polmed scheme and found that there were discrepancies.

The matter was reported to the police.

The couple will appear in court again in June.

Meanwhile a teacher and a funeral parlour owner, who have been charged in connection with an insurance fraud scam amounting to R1.5m, were both granted bail in the Durban Commercial Crime Court on Monday.

Nonhlanhla Gumede and Nkosinathi Zungu were accused of submitting false life insurance claims.

Lieutenant-Colonel Vincent Mdunge said that Gumede, a teacher, allegedly stole people’s ID books and took out funeral policies in their names.

She then claimed from the insurance company eight months later, saying the person had died of natural causes.

Zungu, the funeral parlour owner, allegedly released a body of the same age as the insured person from his mortuary.

On Monday, Gumede and Zungu were granted bail of R7 000 and R10 000 respectively.

The case was adjourned to June for further investigation. - The Mercury

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