Gauteng Compensation Fund backlog raises concerns over doctors’ claims

Alleged delays in approving medical service provider profiles at the Compensation Fund’s Gauteng branch have raised concerns that doctors treating workers injured on duty could struggle to submit claims for payment.

Internal officials have reportedly raised concerns about the pace of approvals, the handling of requests for assistance and the provincial office’s response to escalating complaints.

The fund, however, disputes claims that only 109 medical service provider profiles were approved in Gauteng over a six-month period.

Delays could affect doctors treating injured workers

Medical service provider profiles allow healthcare practitioners to submit claims to the Compensation Fund for treating workers injured while performing their jobs.

According to officials who spoke to The Citizen, only 109 doctor profiles were approved in Gauteng over six months. They argued that the figure was inadequate given the number of healthcare providers involved and the volume of outstanding claims.

One source warned that the alleged delays could have serious consequences if doctors became reluctant to treat patients covered by the fund because they could not submit their medical bills.

“This maladministration will cause doctors to not help patients because the fund simply is not approving profiles, meaning no medical bills can be loaded,” the source said.

Officials also expressed concern about smaller medical claims administration companies that handle submissions on behalf of doctors. If claims cannot be processed, these businesses could face financial pressure and risk damaging their relationships with medical practitioners.

The claims of inadequate approvals and their potential impact have not been independently established.

Officials call for intervention at Gauteng office

The reported delays have prompted calls for stronger oversight of the Compensation Fund’s Gauteng branch.

According to senior officials, repeated attempts to obtain assistance from provincial leadership have allegedly failed to resolve the concerns.

Internal correspondence seen by The Citizen reportedly shows that the matter was escalated after provincial officials allegedly failed to respond to an email requesting assistance.

One senior staff member argued that the province’s handling of its responsibilities had damaged the organisation’s reputation and said previous attempts to secure corrective action had not produced sufficient change.

The official called for the Gauteng office to be placed under administration, with staff reporting directly to head office in an effort to strengthen accountability and oversight.

This remains a proposal raised by officials, rather than a confirmed decision by the fund.

Compensation Fund blames system error

The Compensation Fund has rejected the allegation that just 109 medical service provider profiles were approved in Gauteng during the six-month period.

Spokesperson Hlonitshwa Mpaka said the figure referred to a separate administrative process and had been incorrectly interpreted as the number of approved medical service provider profiles.

Mpaka also attributed delays in the transmission of applications to a system-related problem that affected provincial offices across the country.

She said applications were not successfully transmitted to provincial inboxes between 11 August and 6 September. According to the spokesperson, the issue was resolved by 7 September, after which applications were received and processed.

The explanation points to a nationwide technical disruption, while the allegations from officials raise separate questions about the handling of applications and responses to concerns within Gauteng.

Compensation Fund faces wider scrutiny

The latest concerns emerge as the Compensation Fund faces scrutiny over its administration, governance and payment of claims.

The fund has also faced allegations involving procurement irregularities and reported fraud losses of R71 million, alongside questions surrounding chief financial officer Monaheng Mokoena and whistle-blower claims linked to a R142 million consultant contract.

These issues form part of broader concerns about the fund’s management and its ability to meet its obligations to workers injured on duty.

For healthcare providers, timely profile approvals and claim processing are important to securing payment for services rendered. For injured workers, delays could add to the difficulties of accessing treatment and having medical expenses covered.

While the Compensation Fund says the application transmission problem has been resolved, questions remain over the concerns raised by Gauteng officials and the extent to which the provincial office’s administrative processes are functioning effectively.

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Source: The Citizen