19 arrested for allegedly defrauding GEMS medical scheme of R2.3 million

At least 19 accused appeared before the Nelspruit District Court on Monday (6 March 2023) after they were arrested by the Hawks for allegedly stealing R2.3 million via the Government Employees Medical Scheme (GEMS).

According to Captain Dineo Lucy Sekgotodi of the Saps, it is alleged that individuals within the medical scheme may have conspired with pharmacies to defraud the scheme by submitting claims for services that were not actually provided by the pharmacies.

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The 19 accused are Nkosazane Nyathi (40), Nelile Shabangu (34), Brenda Nzima (38), Nokuthula Ubisi (40), Thabo Ndlozi (38), Muideen Moshood (56), Lucky Lubisi (37), Nomvula Maduna (61), Sipho Mkhatywa (50), Nomvula Tolla (42), Prisca Mokoena (40), Sarah Nyambi (53), Sharon Williamson (38), Veronica Keis (52), Vusi Mkhumbane (66), Victor Mpofu (42) and three entities, namely Valencia, Nala and Buffelspruit pharmacies.

Sekgotodi Valencia, Nala, and Buffelspruit pharmacies allegedly submitted claims to GEMS for services or goods that were not provided to members.

Non-medical goods

Sekgotodi said it was also claimed that GEMS members received non-medical goods in exchange for these false submissions.

“GEMS conducted internal investigations to determine the veracity of the allegations of false claim submissions.

“During the investigation, it was discovered that members of the medical scheme colluded with the pharmacy directors to make misrepresentations to GEMS knowing that what they were doing was not in line with the prescripts regulating pharmacies as prescribed in the regulations.

“The complaint was reported to the Hawks in 2020, whereby an investigation was conducted [and] the arrests made,” Sekgotodi said.

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Sekgotodi confirmed that 14 of the accused were released on R1 000 bail each, while the four pharmacists were released on R5 000 bail each. A pensioner was released on a warning with conditions that they should not commit any similar offence to the one they are on bail for.

The case was postponed to 28 March 2023 for further investigation.