It also banned some doctors and dentists from directly claiming from the medical aid scheme, Permanent Secretary of Finance Calle Schlettwein said on Friday.

The fraud is thought to have amounted to more than N$5 million a year in these cases, although the actual figure could be much higher, Schlettwein said.

The State last year spent more than N$600 million on the fund and its about 140 000 beneficiaries, only 60 000 of whom are paying members.

In some of the criminal cases, the Ministry has already obtained verdicts against medical service providers, while other cases are still pending, with the State now instituting civil claims against them as well.

In most of the cases, the service providers - which included doctors, dentists, a pharmacy and a rehabilitation centre - were claiming more than they were entitled to for medical services rendered to civil servants, Schlettwein said.

Most cases occurred in rural areas where medical practitioners often had a monopoly, documents in possession of The Namibian show.

A rehabilitation centre was made to repay excess claims, while a Katima Mulilo-based doctor, Dr CMJ Ward, lost his right to claim from the scheme after being accused of charging nearly double the average amount claimed from Psemas for consultations.

Psemas is now pursuing a claim of N$6,27 million against Dr Ward, which is being contested.

In another case where the general practitioner has since died, the State is pursuing a claim against his estate to recover several hundred thousand dollars claimed illegally, Schlettwein said.

A case where a Windhoek-based State doctor allegedly claimed more than N$1,4 million a year from "part-time" work at the local hospital was being closely monitored to ensure that this doctor did not break Psemas rules again, Schlettwein said.

Although Schlettwein would not comment on the details of individual cases due to ongoing litigation, one case is known to involve an Oshakati-based doctor who allegedly pocketed millions from HIV treatments by buying cheap generic drugs and selling those at name-brand prices to Psemas patients.

The GP in question has not been formally charged in court yet, Schlettwein indicated.

In another case, a dentist allegedly claimed a fee of N$626 per patient for X-rays, but in fact had no X-ray machine in his practice.

Investigations by a private forensic auditing firm revealed that the dentist had been sending his patients to a nearby State hospital for X-rays, and was charging his fee for interpreting the results.

He has not been criminally charged but claims of more than N$400 000 were withheld until the balance was repaid, said Schlettwein.

The State felt it would punish the community if this practice was closed down.

"The problem was that there were no other dentists in the area," Schlettwein said.

"We therefore could not close this practise down, but have now come to an agreement where this person's monthly claims are monitored by us and the Dental Council to make sure there are no further abuses," he said in an interview.

Pharmacies and optometrists also contributed to the ongoing abuse.

In one case, a coastal pharmacy had deliberately "cooked the books" in its calculations of claims submitted to Psemas, claiming several times more than was due to it, Schlettwein said.

"This pharmacy tried to negotiate to see if they could settle the amount with us but we decided to go ahead and lay criminal charges with Nampol against them," he said.

Schlettwein also confirmed a case where an optometrist allegedly gave glasses to everyone who had their eyes tested in a small town, whether they needed it or not.

This optometrist, a South African-owned chain, was made to repay more than N$80 000, documents in possession of The Namibian showed.

"There is an inherent conflict of interests with optometrists - they do the testing [of the patient's eyes], as well as issuing the prescription," he said.

Prescriptions were also "adjusted to patient's non-medical needs" by claiming for designer frames when none were issued or selling sunglasses but claiming these as medical prescriptions, he said.

As a result, the MoF has now implemented an agreement whereby doctors have to approve optometrists' prescriptions before Psemas would pay out the claim, he said.

Psemas patients would only be allowed one pair of glasses a year, he said.

Schlettwein said the Ministry of Finance has been implementing several measures to curb abuse of the medical aid scheme, including setting up a Cabinet Committee in May last year to oversee the scheme.

A private management consulting firm - Pinnacle Management Consultants - had been policing the Psemas records until the middle of last year, but their contract had expired, Schlettwein said.

A decision was taken to split the various technical aspects of managing Psemas - ranging from actuarial services to administration and auditing of Psemas accounts - and a tender for this purpose was issued late November 2007.

No offers were received, and the MoF would therefore issue a similar tender again, perhaps as soon as this week, Schlettwein said.

The Ministry was also investigating the possibility of biometric Psemas member cards, which would list every would-be claimant's full records, including previous claims, every time it was submitted, he said.

* John Grobler is a freelance journalist; 081 240 1587

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