AN independent black pharmacy has taken medical schemes to the Equality Court for allegedly unfairly terminating his contract and discriminating against him.
The owner of Amalig Pharmacies, Alfred Mokoditoa, approached the court after the medical schemes terminated his contracts.
He said this was based on trumped-up charges and irregular audits which resulted in the Government Employment Medical Scheme (Gems) blacklisting his pharmacies.
As a result, Mokoditoa had to close his four pharmacies in 2011.
The pharmacies were small enterprises in Atteridgeville and downtown Pretoria.
Mokoditoa said the pharmacies were blacklisted despite him being questioned, arrested, and appearing before the court of law.
He said the medical schemes orchestrated trumped-up charges against him. Mokoditoa claimed the aim was to destroy successful black practices and allow white corporate-owned pharmacies to flourish.
Mokoditoa said these “lawlessness” acts were protected by the Council for Medical Schemes (CMS) which was supposed to ensure that all entities conducting the business of medical schemes comply with the Medical Scheme Act.
In his court papers, the respondents are CMS, Discovery Health Medical Scheme, Bonitas Medical Scheme, Medscheme Administrator, Hosmed Medical Scheme, the SAPS Medical Scheme and Gem.
The matter is expected to be heard on August 18.
Mokoditoa said the schemes allegedly used spy tapes to monitor to deal with him. He said his difficulties started between 2004 and 2005 when he received a call that the owner of Blackrock, one of his pharmacies, must contact the forensic unit of Discovery Health Medical Scheme regarding the investigation which was conducted against the pharmacy. He said he was then informed that the scheme conducted an investigation against Blackrock and they were in possession of the video footage obtained by one of the spies working for him.
Mokoditoa said he was told that Blackrock had been submitting fraudulent claims for non-medicinal products such as Baby Formula Nan 1, Pampers Baby Nappies 3, toothpaste, and washing powder.
“I was given a choice to either come up with a settlement of paying the scheme the money it lost or suffered for the period of three years due to alleged fraudulent claims against Blackrock, or the scheme was going to report the owner of Blackrock to the SAPS and the South African Pharmacy Council ( SAPC).”
Mokoditoa said he rejected the proposal and indicated that he needed to get the other side of the story from the “responsible pharmacist of Blackrock” but he was told that there would be negative consequences for non-co-operation.
He said he told Discovery to go ahead and report the matter to relevant authorities.
Mokoditoa said he reported the matter to CMS and the case was investigated. He said Discovery Health Medical Scheme later bullied and threatened him with a court action to remove all the notices in his pharmacies and forced him to sign an acknowledgment of debt (AOD) of R30 000 for Blackrock.
He said the AOD was not part and parcel of the medical scheme contract between Blackrock and Discovery, saying the R300 000 AOD was unlawful.
Mokoditoa said other schemes followed and used the same modus operandi. He said Bonitas stopped making benefits due to Blackrock. The letter from Medscheme also followed indicating that Blackrock was involved in irregular and fraudulent activities. The administrator suspended benefits to Blackrock.
He said Hosmed also followed suit in 2007. This was after Mokoditoa realised that Hosmed payment did not reflect on his pharmacy's bank statements. He said he never received any notification to that effect.
Mokoditoa said his pharmacy group also rendered health services for over R1 million to Polmed members. He said the claims were received, accepted, and processed and authorisation numbers were issued. However, instead of effecting benefits, the scheme alleged fraud on all claims submitted and opened a criminal case against Mokoditoa. The benefits were also withheld.
Mokoditoa said this resulted in him lodging a complaint with the Special Investigating Unit (SIU) against four senior managers of CMS.
He said the four failed to enforce compliance with section 59(2) of the Medical Schemes Act (MSA) against Medscheme and Hosmed.
He said another manager issued a fake ruling of the CMS Appeal Board in favour of Polmed. He said the four were dismissed by CMS on December 13, 2019, following the SIU investigation.
“Corruption at the council for medical schemes has destroyed my pharmacies businesses and I am seeking an order for the amount of R228 600 000 for harassment, pain, suffering, emotional distress, and racial profiling caused by the first respondent.”
On Thursday, CMS spokesperson Stephen Monamodi said the regulator was aware of the application and has duly filed its responses. Monamodi said CMS, as a regulator respects the decorum of legal processes.
“We will wait on the Equality Court to make a decision. But most importantly, our mandate as contained in Section 7 of MSA – which is to protect the interests of medical scheme members – requires us to adjudicate medical scheme complaints in a fair and transparent manner,” said Monamodi.
Hosmed said they were looking into the query. Discovery Health Medical Scheme requested a deadline of Friday noon. Bonitas also said they were looking into the query.
Gems principal officer Dr Stan Moloabi said: “The Government Employees Medical Scheme is always grateful to the media for providing the scheme with an opportunity to comment. As you are no doubt aware the merits of this matter are scheduled to be heard on 18th August 2023 before the Equality Court of South Africa. Given that the matter is sub judice, GEMS is not in the position to comment at this stage. The media are welcome to attend the hearing to obtain insight on the matter, more specifically the Scheme’s position. We look forward to engaging with you in the future should you have any queries.”
Senior manager in public relations, reputation management and stakeholder relations Tebogo Mashego, who responded on behalf of Medscheme, said the scheme has filed a comprehensive response.
“As the matter is in its infancy and as, at the moment, the parties are awaiting directions from the court as to the status of the matter and future conduct thereof, which may have a material impact on the content of further affidavits to be filed on the part of Medscheme and other parties, we cannot at this stage comment on the bases of the defences raised to the claims of Mr Mokoditoa and his related claimants, save to state that Medscheme believes that there is no merit to any of the claims,” said Mashego.