Prosecution for fraudulent activities

Section 16 of the Medical Schemes Act places an obligation on Council for Medical Schemes to report cases of improper or disgraceful conduct (Unprofessional Conduct) to a medical scheme by practitioners registered with HPCSA to the HPCSA as the statutory body which has jurisdiction over practitioners registered under the Health Professions Act.

Where a criminal offence has been committed, the Council for Medical Schemes is obliged to refer such a matter to the National Prosecuting Authority. The medical schemes cannot discipline or prosecute health practitioners for unprofessional conduct, but may report practitioners to the HPCSA for unprofessional conduct or report any criminal offence to the South African Police Service (SAPS).

Section 34 of the Prevention and Combating of Corrupt Activities Act, 2004 (Act No. 12 of 2004) requires that anyone in position of authority or an entity (medical schemes, HPCSA, etc.) that suspects or has knowledge that a practitioner has been involved in a fraudulent activity that involves an amount of R100 000 or more to report such knowledge or suspicion to the South African Police Service. Failure of such a person or entity to comply with this provision of the law constitutes an offence under the Act mentioned above.

Practitioners are advised that those found guilty of unprofessional conduct involving fraud amounting to R100 000 or more will not only be subjected to penalties imposed in terms of Section 41 of the Health Professions Act but Council will also report such practitioners to SAPS in terms of the Prevention and Combating of Corrupt Activities Act.

Guidance provided here is not exhaustive and practitioners are advised to approach Council for further advice by directing an e-mail to Professionalpractice@hpcsa.co.za  for guidance on ethico-legal matters. 

Council commits itself to a turnaround time of 10 working days to respond to any request for advice and/or guidance through the e-mail provided above.