Johannesburg - The inquiry into the allegations that medical schemes racially profiled black doctors has heard how Discovery Medical Aid recently entrapped a doctor into issuing fraudulent sick notes and then investigated him.
Discovery also tricked two other doctors into submitting fraudulent bills, Yvonne Naidoo, a lawyer from Elsabé Klinck & Associates said at the inquiry on Wednesday.
The scheme then turned around to inform the doctors that it had launched forensic investigations into their practices and withheld all money due to them, Naidoo said.
The doctors, who are all black, were then informed that in order to make their troubles go away they should enter into acknowledgement of debt agreements with the scheme.
The inquiry chaired by advocate Tembeka Ngcukaitobi has previously heard anecdotes about alleged unethical conduct of schemes when probing doctors it accused of fraud.
The probes have been described as a bullying tactic intended to embarrass doctors into paying medical schemes over "concocted" debts.
Naidoo, from a firm that often represented doctors in their disputes with schemes, offered some of the traceable examples of the alleged unethical conduct by schemes.
Medical schemes will testify late next month, where they are expected to defend themselves.
The doctor entrapped to issue a fake sick note, according to Naidoo, was sent a letter inviting him to a meeting to discuss the alleged breach.
"By the time the client received this letter his claims were already suspended," said Naidoo.
"The client wasn’t informed but he could pick up from the claims that he submitted that he wasn’t getting paid.
"It was disclosed in the meeting that the client was already under suspension," she said.
At the meeting, Discovery revealed footage that proved the issuing of the fraudulent sick note.
Naidoo said the footage was clandestinely taken by phone by someone posing as a worker who did not want to go to work because it was a Monday.
"(The footage) showed several days of probes that were sent in and who physically took video footage of the doctor and requesting, basically, as if they luring the doctor to give them sick notes," she said.
Seeming well-trained, the person was heard in the footage making friendly chit-chat with the doctor to befriend him.
"You can see that the healthcare professional is completely caught off guard. He has no idea that he’s being (filmed) and he would then present a patient with a sick note," Naidoo said.
Naidoo also dealt with two cases of doctors tricked into servicing people not covered by the scheme.
"In other cases there were two probes. The one posed as an elderly lady, (while) she was a daughter of a younger probe.
"Then the younger probe would then say to the doctor, 'can you please just assist my mom because she’s not feeling well and she doesn’t have medical aid. We can just claim from my medical aid'," said Naidoo.
In meetings, schemes wanted the entrapped doctors to quantify how much they defrauded it over the last three years and enter into agreements acknowledging debt.
Asked by Ngcukaitobi to name the scheme she was referring to, Naidoo said: "It’s Discovery Health."
Elsabé Klinck, managing director of Elsabé Klinck & Associates, said doctors took the treatment they were subjected to by schemes too hard. Many broke into tears when consulting with her, Klinck said.
Ebbie Iheanyi, another lawyer from the firm, said the pattern of probes raised eyebrows. The volume of documents demanded from them sought to burden them, she said.
"It feels like there’s an administrative burden on this small practice and it comes across to say if not for race, what else?"
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