Pretoria - A forensic investigator on Monday lifted the lid on a scam that saw a doctor allegedly defrauding the Department of Labour’s compensation fund of almost R400 000.
The fund provides compensation for disablement caused by occupational injuries or diseases sustained or contracted by employees in the course of their work, among others.
Dr David Michael Adams is facing 29 counts of Section 6 of the Prevention of Organised Crime Act. He is also facing 29 counts of theft.
During testimony of his investigation into the alleged crimes, Hendrick Beukes told the Pretoria Magistrate’s Court that he spotted an eyebrow-raising transaction amounting to about R4 500 for a medical consultation.
“In one of the claims he claimed R4 500, which was unheard of in the rates of a general practitioner,” Beukes told the court. He said this was one of 29 transactions that were picked while investigating Adams.
Beukes, who at the time was employed by PKF Auditors and Consultants, said all the transactions that took place from 2007 contained a series of numbers pertaining to the processed claims.
“I noted that all the numbers dated back to 2007 and it’s highly unlikely for unique numbers for claims spanning a few years to be processed in one day,” Beukes said.
He said some of his duties entailed working with investigators from other firms, interrogating systems of data captured on the department’s mainframe regarding claims made by service providers, which included doctors and specialists. “Upon investigation we were given information of high volumes of claims which we found to be irregular.”
According to Beukes, general medical practitioners and physiotherapists needed to subscribe to tariffs published in the Government Gazette, which stipulated the amount of money each practitioner was allowed to bill.
“Some of the claims exceeded those that were published. An IT specialist made an extraction from the data base, highlighting the specific doctors identified in high volume and expensive claims,” he said. “The accused was one of the doctors identified.
“We were provided with all the information and relevant claim numbers and names of patients and companies they worked for with the type of injury, including amounts,” Beukes said.
Adams, who has pleaded not guilty, had a practice in Lehurutshe, North West.
Pretoria News