28 September 2021
For immediate release
The South African Society of Physiotherapy responds to misleading claims about fraudulent practitioners
“As the professional body representing the majority of physiotherapists in South Africa, we have good reason to believe that fraud by physiotherapists is a very, very rare thing,” says South African Society of Physiotherapy (SASP) President Lonese Jacobs.
Jacobs was responding to an incredibly misleading story in BusinessTech on 27 September (quoting a News24 article), which stated that the government employees’ medical scheme, GEMS, claimed that medical funders are losing R22 billion a year to fraud, mentioning, among others, “common fraudulent claims come from dieticians and physios billing for services they do not render”.
“If any physiotherapists in South Africa are proven to be practising fraud, of course they should face the full might of the law,” says Jacobs. “One of the pillars of the profession is ethical behaviour, to patients, fellow practitioners and other stakeholders, and we strongly condemn any behaviour contrary to these principles.”
She went on to say, “The clear implication of the BusinessTech article is that fraudulent behaviour by physiotherapists is commonplace, and that is simply not true,” she says. “If it was, the SASP, which represents the bulk of the private sector physiotherapists billing medical schemes, would undoubtedly know about it. In fact, our peer review committee deals with many cases where coding errors are found, but very few where outright fraud is discovered or even claimed by the funders; most cases are the result of interpretation issues.” (‘Coding’ refers to the complex codes medical practitioners use to indicate what treatment was given.)
The SASP was not involved in the course of this investigation, and GEMS asked for only one meeting with the organisation, on a single element of the coding used by physiotherapists. “The information we have is very sketchy, but what there is indicates that very small numbers of physiotherapists have been investigated; 24, we were told, had ‘changed their behaviour’. This is not the language you’d use about outright fraud and deception – it’s the language appropriate for misunderstanding of codes or human error – which is, it appears, largely what this is about.”
Jacobs continued “…physiotherapy is an evidence-based profession; and we would like to see GEMS’ evidence for any claims that physiotherapists are behaving fraudulently”
The SASP would also like to see evidence backing the claim that the loss to the Industry due to fraud amounts to R22 billion. “This figure can only be an estimate, as no study has been done on this. It is thought that between 5% and 10% of claims involve fraud (and this is based on international figures, which are also a guesstimate), but R22 billion is an arbitrary sum on the high side and cannot be judged to be authoritative without evidence,” says SASP Deputy President Rogier van Bever Donker.
Adds Jacobs, “If anything, what the comment in this story highlights is not that physiotherapists behave fraudulently when billing medical schemes, but that coding is subject to misunderstandings and errors – something we can help with. It is our mandate as the professional body to educate members on coding; if the medical schemes would consult us in a collegial and not adversarial manner, we could help to resolve these situations swiftly, especially with the input of the massive combined clinical experience and knowledge within our Special Interest Groups.”
As mentioned, the SASP has its own peer review process, and a Forensic Audit Committee which draws on both clinically appropriate expertise and coding skills to assess complaints against its members.
“We invite GEMS and all medical schemes to engage with us, to share their data and work with us collaboratively, in the interests of better and fairer medical care for our nation.”
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