Pair allegedly defrauded medical aid of R47m

By Tania Broughton Time of article published Mar 24, 2005

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Assets worth R31-million belonging to a disgraced Durban doctor and his associate, who allegedly defrauded medical aid schemes of millions of rands, were seized on Wednesday.

Among the assets seized were houses in Umhlanga and La Lucia, a property at Zimbali estate, all their household goods, three vehicles and their interests in five companies.

Twelve bank accounts and R1-million in bail was "restrained" by curator Trevor White in terms of an order granted by Durban High Court judge Kevin Swain this month.

Moonsamy Soobramoney, of Cordia Crescent, Umhlanga, and Maliga Pillay, of Addison Drive, La Lucia Ridge, have appeared several times in the Durban regional court, charged with 75 '383 counts of fraud.

It is alleged that the pair used other doctors' practice numbers and, acting in cahoots with medical aid members, submitted false claims to five medical aid schemes totalling R46,6-million. They were paid out R31,2-million. A trial date is expected to be set in May.

Recently, dozens of correctional services staff were arrested in connection with the same scam.

In a behind-closed-doors application before the judge on March 7, the director of public prosecutions obtained an order to freeze all

assets belonging to Soobramoney and Pillay, pending the outcome of the trial.

The application also affected assets in the name of Soobramoney's wife, Manogarie, and his mother, Pumaney.

In an affidavit before the court, Scorpions senior special investigator Johannes "Hans" van Loggerenberg said he had been tipped off about the alleged scam by Advocate Vas Soni, the evidence leader at the Jali Commission of Inquiry.

His investigations revealed that Soobramoney had been registered as a doctor in 1990 but was removed from the register in November 2002 for "rendering accounts for fees not entitled to".

Forensic accountants KPMG did an audit of 75 383 claims made by the two between January 1999 and August 2001 to Medihelp, Medscheme, Metropolitan Health, Old Mutual Healthcare and Status Medical Aid.

The audit report says:

- Soobramoney and Pillay had used the practice number of Dr Selwan Soobramoney Ramsamy (Soobramoney's brother) to submit more than 31 000 claims to Medihelp valued at R19,5-million. The scheme paid out R14,3-million.

- The pair used the practice number of Dr Ravindra Magan Soni to make claims valued at R6,6-million. Medihelp paid out R4,3-million.

- In 1999 they fraudulently submitted an application to the Board of Health Care Funders for a practice number in the name of Thoeshay Medical Centre, which was purportedly being run by Dr Selwan Soobramoney and Prashene Govender. They then submitted claims valued at R15,6-million, of which Medihelp paid out R10-million.

"They used a similar modus operandi to defraud other schemes," the investigator said.

He said two of the schemes had taken civil action against the pair, but they had settled out of court for R6,1-million.

Soobramoney and Pillay have until May 6 to oppose the application.

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