The Sunday Mail
. . . Corporate24 clients set for reprieve
Africa Moyo —
CIMAS Medical Aid Society members, who are clients of Corporate 24 Hospital Group and were placed on cash payment after an operational tiff between the two, could get a reprieve soon following the recent completion of a forensic audit.
The forensic audit was initiated after Cimas — the country’s second largest medical aid society after Premier Service Medical Aid Society (PSMAS) — suspected that Corporate 24 had submitted fraudulent claims. Corporate 24 has denied the allegations.
Former Cimas managing director Mr Rodrick Takawira, who resigned under a cloud in September this year, hinted on April 21, 2016 in an information bulletin circulated by the company that direct payment to Corporate 24 would be “reviewed” upon the conclusion of a forensic audit that was underway.
The forensic audit has since been finalised and “a copy was sent to the regulator, the Ministry of Health and Child Care, on November 22, 2016”, according to Cimas chief executive officer Mr Vulindlela Ndlovu in emailed responses to The Sunday Mail Business.
The findings of the forensic audit could not be established but members are optimistic that a solution would be found to the long running saga which has put the lives of members, who don’t have extra money to pay for medical services, in jeopardy. Government has been mediating the impasse from February this year but has overally failed to bring the two to a common ground.
Cimas is still not been accepting claims directly from Corporate 24 and its members have to pay cash and would be refunded by the institution, which has been seen as an inconvenience by members and Government.
Reports have suggested that Cimas owes Corporate 24 in excess of US$500 000 in unpaid claims and the latter was threatening to engage debt collectors to recover the money directly from members. But Mr Ndlovu insisted they don’t “owe Corporate 24 anything”, and pledged to “assist” members with the correct position.
“Our experience so far reveals that there are instances whereby the claims being made are not valid. Please be advised that Cimas does not owe Corporate 24 anything.
“We have not been accepting claims directly from Corporate 24 since June 2015. Our members can, however, go to Corporate 24 and pay cash and thereafter claim from us.
“This position has been communicated to both Corporate 24 and our members on numerous occasions. Consequently some of our members have paid for services from Corporate 24, claimed a refund from us and been paid a refund,” said Mr Ndlovu.
Mr Ndlovu explained that early this year, Cimas discovered that Corporate 24 had continued to treat its members without requiring them to make payment prior to treating them.
Cimas says it agreed to pay for all valid claims from Corporate 24 up to March 28, 2016 despite there being no contractual obligation to do so and “as a gesture of goodwill”.
Since January this year, Cimas has paid just over US$180 000 for 8 241 claims filed by Corporate 24. Cimas members got almost US$116, 500 as refunds after having paid for themselves while Corporate 24 pocketed close to US$54 000. A shortfall of almost US$10 000 was recorded.
A shortfall is the difference between the claim and the applicable benefit. Mr Ndlovu said it was surprising that the bulk of the claims sent by Corporate 24 were in fact claims seemingly being submitted on behalf of Cimas members as they were accompanied by receipts indicating that members had paid for services received.
Cimas says it is financially sound and pays in excess of 3000 service providers every month. A system where medical aid subscribers are forced to pay cash upfront is largely discouraged in the sector as it goes against the essence of medical insurance.
Last year, Cimas clashes with the National Physicians Association of Zimbabwe, the Zimbabwe Hospital Doctors’ Association and the Retail Pharmacists Association of Zimbabwe over various matters.
