Cape Town - A second health-care practitioner has been convicted and sentenced for defrauding the second largest open medical aid scheme of R87000.
Clinical psychologist Henny Tinyiko Mavasa, 31, was submitting fraudulent claims on Bonitas Medical Aid Scheme members for more than two years.
He was found guilty by the Johannesburg Specialised Commercial Court of medical aid fraud and of 60 counts of contravening Section 66 of the Medical Schemes Act.
Mavasa pleaded guilty last week under Section 105A of the Criminal Procedure Act 77 of 1951 and sentenced to a fine of R60 000, or three years in prison.
He was sentenced to a further three years’ imprisonment, suspended for five years by the Court, which noted that he had already paid back the R87000 to Bonitas.
On August 1 audiologist and speech therapist Wandile Theophilus Mashego was found guilty of defrauding Bonitas of R506 000, and was ordered to pay back the money.
He was found guilty of 259 counts of medical aid fraud and one of contravening Section 66 of the Medical Schemes Act.
As part of his sentence, Mashego was ordered to subject himself to stringent conditions including house arrest, a suspended prison sentence, community service and correctional supervision.
Bonitas chief operating officer Kenneth Marion said: “The repercussions of fraud are widespread, but it has a direct impact on every member of the fund.
“Medical schemes are not for profit and are, in fact, owned by their members. So, when the scheme is defrauded, it impacts funds to pay for claims and can contribute towards increased premiums.
“Last year R31.2 million (fraud money) was recovered.”
He said fraud and medical aid abuse might only be committed by a small number of health-care providers, but it was a major cost-driver in terms of financial impact.
He said fraud added between R192 and R410 extra a month to every principal member’s medical aid contributions.
“Bonitas currently has 33 cases, which are in various stages of the criminal justice system,” Marion said.