Teachers, nurses arrested for medical aid fraud

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Nappies and formula milk are some of the items that got 18 people who include government employees and pharmacy employees into trouble in a racket that fleeced R2,3m from the Government Employees Medical Scheme (Gems).

According to SowetanLive, the suspects appeared in the Nelspruit magistrate's court yesterday on charges of fraud. The state alleges that Gems members who included nurses and teachers colluded with four pharmacy owners in Mbombela to buy items that are not covered by the medical scheme and, in some instances, exchanged their medical aid savings for cash. According to hawks spokesperson in Mpumalanga Dineo Sekgotodi, the first case was registered in November 2020 in Mbombela.

 

“The modus operandi was that the government employees would go buy items at these pharmacies and make claims that they bought either medical items covered by their medical aids and this was a lie. Some of the items they bought include soap," said Sekgotodi. She said the items would be sold to the medical aid member at exorbitant amounts and the accused would split the money from their savings. She said the accused handed themselves to the hawks yesterday. Magistrate Eddie Hall gave the four pharmacy employees R5,000 bail each, while 14 government employees were granted R1,000 bail each. Sekgotodi told Sowetan that the state is looking to make more arrests.

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