‘Serious consequences’: Compensation Fund backlog allegedly threatens doctors’ claims in Gauteng
· Citizen
The Compensation Fund’s Gauteng branch is allegedly battling massive backlogs in approving medical service providers, with internal sources saying doctors treating injured workers could be left unable to submit claims for payment.
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There is growing frustration among officials over what has been described as persistent maladministration and a failure by the office to respond to repeated requests for assistance.
Concerns over doctor profile approval delays
The problem centred around the approval of doctor profiles, which allows medical service providers to submit claims to the fund for treating workers injured on duty, senior officials told The Citizen.
According to officials, only 109 Gauteng doctor profiles were approved over six months – a figure described as inadequate given the number of providers and the growing volume of outstanding claims.
The fund disputes this.
“The backlog could have serious consequences for injured workers if doctors become reluctant to treat Compensation Fund patients because their profiles had not been approved and medical bills could not be submitted,” a source said.
“This maladministration will cause doctors to not help patients because the fund simply is not approving profiles, meaning no medical bills can be loaded.”
Another official said smaller medical claims administration companies, which manage doctors’ claims on their behalf, could also suffer financially if the delays prevent them from processing claims and maintaining their business relationships with medical practitioners.
Officials call for Gauteng office to be placed under administration
The concerns have prompted calls for stronger intervention in the Gauteng office, with internal correspondence showing repeated attempts to secure a response from provincial officials had yielded little progress, the official said.
“The province’s handling of its responsibilities had damaged the organisation’s reputation. Corrective action had been sought in at least two instances, but escalating concerns to the provincial office’s senior leadership had failed to change the situation,” the senior staffer said.
The official called for placing the entire Gauteng provincial office under administration, with officials reporting directly to the head office to improve oversight and accountability.
Correspondence, which The Citizen has seen, indicates the matter was escalated internally after Gauteng officials allegedly failed to respond to an e-mail seeking assistance.
Compensation Fund blames system error for application delays
Hlonitshwa Mpaka, the fund’s spokesperson, said there were system-related interruptions that affected the transmission of applications nationwide, not just in the Gauteng office.
She said from 11 August to 6 September, applications were not successfully transmitted to provincial inboxes, due to this error.
“By 7 September, the issue had been resolved. Applications have subsequently been received and processed.
“The Compensation Fund categorically disputes the allegation that only 109 medical service provider profiles were approved in Gauteng during the six-month period. The 109 relates to a separate administrative process and has been incorrectly interpreted as representing MSP profile approvals,” Mpaka said.
The fund has been rocked by allegations of procurement irregularities, governance failures and delays in paying claims.
It has also been grappling alleged fraud losses of R71 million, questions around its chief financial officer, Monaheng Mokoena, and whistle-blower allegations involving a R142 million consultant contract.