Corporate 24 Hospital (C24) is owed more than $500 000 by Cimas Medical Aid Society in unpaid claims since June last year, prompting the former to demand its dues directly from the Cimas members who were treated during that period, The Herald has learnt.
In a recent interview over the longstanding dispute, Corporate 24 Hospital group chief executive Dr Mike Joka said the decision to recover its money for services rendered from Cimas members directly was necessitated by the society’s failure to acknowledge claims by the hospital. Dr Joka said the financial prejudice that his institution suffered since the dispute is estimated to be around $2 million.
Corporate 24 is owed over half a million in unpaid claims since June last year, but the financial prejudice over the 16-month period is around $2 million considering the fact that prior to the ban, Corporate 24 was claiming between $100 000 and $120 000 every month from Cimas alone, said Dr Joka.
He said the decision to recover money directly from patients was one of the toughest decisions the hospital had to make to ensure that their business remained sustainable.
“Carrying the burden of continuously giving service without knowing when you will get paid had become unsustainable. “We tried to wait for a resolution of the impasse, but as you are aware, the matter is getting closer to two years now but still there seems to be no solution anywhere near,” said Dr Joka. “The time has come to implement strategies that ensure our survival.”
Dr Joka accused Cimas of negotiating with both Corporate 24 Hospital and the regulator in bad faith, arguing that sometime in March this year, it was agreed that Cimas would pay all outstanding claims and lift the ban on Corporate 24, but Cimas reneged on this agreement and only paid $38 000.
He also accused Cimas for using its forensic audit on C24 Hospital as an excuse to avoid paying its dues.
“Cimas just used the forensic audit as a tool to unlawfully avoid paying us for the services rendered to its membership. They repeatedly acted in bad faith giving everyone, including their members, false assurances,” said Dr Joka.
However, Cimas chief executive Mr Vulindlela Ndlovu denied all allegations levelled against his organisation, arguing that Cimas had an obligation to indemnify its members and its actions were also in the best interest of those members to protect potential abuse of their benefits.
Contrary to the hospital’s claims that Cimas reneged on its commitment to pay all outstanding claims, Mr Ndlovu said his organisation did process all claims they had at that time and paid C24 Hospital.
Although he could not immediately provide the figures of the claims paid, Mr Ndlovu said C24 continued to accept patients on Cimas even after advising them against treating their members due to “irregular claims”.
In relation to C24’s latest move to demand the money owed directly from Cimas members, Mr Ndlovu advised their members to settle the bills and claim reimbursement from the society.
“From the beginning, we have done everything possible to appraise members of the situation through the various platforms we communicate with our members. “Updates have been sent time and again. Members with queries have also been addressed directly,” said Mr Ndlovu.
He said results of the forensic audit carried on C24 Hospital were expected any time soon without giving a specific timeframe. He said a forensic audit was something that could not be rushed as there were many aspects to be looked at.
“The forensic auditors have issued us with a draft report which they require us to review and tender our comments. “Once we have submitted these comments, they will issue a final report. Once the report has been finalised, we will submit it to the regulator, who will then deal with the matter as he deems fit,” said Mr Ndlovu.
Contacted for comment, Health and Child Care Deputy Minister Mr Aldrin Musiiwa expressed concern over the dispute between Cimas and C24, saying Government expected a lasting solution.
Mr Musiiwa said both parties should quickly find a solution for the benefit of their clients. The dispute between Cimas and Corporate 24 revolves around suspected fraudulent claims submitted by the latter, prompting Cimas to institute a forensic audit to investigate the authenticity of the claims. Herald