Malawi’s health account defrauded in SA

Fraud has rocked Malawi’s health referral account in South Africa, costing Capital Hill millions of kwacha and risking lives of Malawians seeking treatment there.

Documents we have seen expose “calculated fraudulent transactions” from July 2008 to March 2010, leading to the health referral system’s abuse.

There are now fears that the racket could have started earlier than 2008 and may have cost Malawian taxpayers hundreds of millions of kwacha since, according to official investigative documents we have seen, there has never been an audit of the referral services procured through the Malawi Consulate in SA.

The abuses included inflated invoices by South African (SA) hospitals and fraudulent claims allegedly aided by Malawian diplomats at the Johannesburg Consulate who recommended payments to undeserving service providers, according to a draft internal audit report carried out on the Health Office of the Malawi Consulate General in Johannesburg.

In April 2010, ministries of Health and Foreign Affairs, backed by the Office of the President and Cabinet (OPC), mounted a joint audit into allegations of payments being made to a pharmacist assistant who even invoiced for services such as chemotherapy treatment and surgeries that can only be offered by medical specialists.

The audit, which followed whistle-blowing by a driver at the SA Consulate’s Health Office, established the possibility that Malawi’s health office in Johannesburg was sometimes conniving with unqualified health personnel to invoice for services wrongly provided or not provided at all.

Dubious transactions

In a specific case—the subject of the audit—involving one Kate Maboko, a pharmacist assistant (post-basic), the Malawi Consulate in Johannesburg was  allegedly duped of ZAR245 838.52 (about K4 916 770.40 at the 2010 exchange rate or K8 604 348.20 at the current rate).

This money could have helped 50 Malawian cancer patients undergo chemotherapy, a cancer treatment out of reach to most Malawians and not widely available in the country.

This estimate is based on one invoiced cost of ZAR5 000 (K195 000) for one Malawian patient who benefitted from the referral arrangement in SA.

Maboko is registered as a pharmacist assistant (post-basic) under the Southern African Pharmacy Council, but masqueraded as a fully-qualified pharmacist, according to official documents—both from South African and Malawian authorities—we have seen.

She used her assumed qualification to render services to Malawi Government-sponsored patients without the capacity to do so; thereby putting lives of Malawian patients in danger, according to the audit.

Despite using different registration numbers which turned out to be fake, Maboko’s questionable invoices slipped through the fingers of health attache Davies Mtotha, whose office at the embassy was specifically created to check fraudulent claims to ensure Malawi got value for its money.

In one of the correspondence we have seen, the Southern African Pharmacy Council identified her name as Kate Nobantu Maboko, registered as pharmacist assistant (post basic) with her practice number being P18976.

But in all her invoices to the consulate, she was not using her practice number; instead she was using either number 14567 or 20349806, according to the audit findings. Some of the invoices, it observes, have no practice numbers.

Audit faults health attaché

Mtotha has since been recalled from the consulate and the audit recommended that he should answer for colluding with Maboko to defraud the government of its resources.

Said the report: “It is conclusive from the findings that Mr Mtotha colluded with one Kate Nobantu Maboko to defraud the Malawi Government of its resources.

“The findings affirm that Mr Mtotha has a case to answer; and it would be in the interest of the service that he must account for the sum of ZAR245 838.52 (K4 916 770.40 [at 2010 exchange rate or K8 604 348.20 at the current rate]).”

But his parent ministry, Health, doubts his involvement in the scam and has since posted him to Kamuzu Central Hospital (KCH) as deputy hospital director.

Ministry of Health spokesperson Henry Chimbali this week dismissed assertions that Mtotha connived with Maboko to defraud the health account but admitted that the former attaché was recalled due to the alleged irregularities.

“To say that Mr Mtotha was conniving to defraud government may not be true. However, the arrangement that was being followed as regards the payment and procurement of medicines for patients that have been referred to South Africa had some irregularities.

“Because of these irregularities and other factors as well, Mr. Mtotha was recalled from South Africa. Mr. Mtotha is back in Malawi and is working at Kamuzu Central Hospital,” said  Chimbali in an e-mailed response.

Mtotha himself, in an interview on Wednesday this week, denied all the allegations levelled against him, saying “all this was coming out of office politics at the consulate.”

“If there was anything wrong, I would have been queried but nothing of that sort happened. My enemies are not happy that I am still in the system,” he said.

Put to him that Maboko, a mere pharmacist assistant sometimes invoiced for services that can only be done by surgeons but which he approved, Mtotha insisted that all the people who provided medical services were qualified for the services they were paid for.

“That is why the people who came to do the audit found nothing. Unfortunately, I was not even given the final report,” he said.

More money lost

According to documents we have seen, the health office at the SA consulate was established in 2006 to avert several losses Malawi incurred under the previous systems.

Initially, Malawi paid for medical services in SA through agents but government realised that they were inflating patients’ bills.

Government then changed and started transferring funds through the consulate to cater for medical costs for referrals.

Later, it transpired that the money would often be misappropriated by consulate staff.

“Government discontinued this type of arrangement and started remitting the monies directly to the hospitals where patients received treatment. Again, this arrangement had its own shortfalls as government realised that some unscrupulous hospitals had found a way of falsifying medical costs,” notes the report.

Unfortunately, what government thought would be the best way to control costs—establishing the health office housed within the SA consulate—ended up being another loophole, according to the audit, which Chief Secretary Bright Msaka authorised.

Former Secretary for Foreign Affairs Anthony Livuza wrote Msaka on April 7 2010 informing him that his office, in conjunction with former Health Secretary Chris Kang’ombe, was informed of fraudulent activities that implicated Mtotha; hence, the need for an investigation.

Official documents also indicate that the health unit had never been audited “despite handling large amounts of government funds meant to save lives of Malawians in need.”

This could mean that the Maboko case may just be a tip of the iceberg, prompting the audit team to recommend a full audit exercise.

Chimbali said government has now reorganised the health unit at the Malawi Consulate in Johannesburg to close all loopholes that allowed fraud.

He said in an e-mail: “We have developed guidelines that have to be followed as regards referrals and payments for services and this has significantly improved the operations of the attaché office in South Africa. These guidelines stipulates on payments and the accounting process as well as other administrative issues.”

How fraud occurred

Weekend Nation studies of documents relating to the matter indicate that among other irregular activities in the consulate’s health office was that nobody in the section ever followed up patients referred to SA for treatment.

The only point Mtotha and officers in the section would deal with the patients again was at the time of honouring payments, most of them done without verification to ascertain treatment provision.

In one of her invoices seen by Weekend Nation, Maboko claimed to have offered services such as drug tolerance test and mitigation of reactions, toxicology tests for generalised paraesthesia and tolerance tests for Sotazideconvulex Aminopyan, on a Malawi patient as allegedly referred to her by Dr. Rassik Gopal of Gauteng Oncology.

But in a letter that we have seen, Dr. Gopal denied referring the said patient to Maboko yet, Mtotha, the health attaché, endorsed her payment through Malawi Government voucher number 254 dated 16 September 2009 and was paid through cheque number 102368.

Said Dr. Gopal: “I occasionally receive patients from Malawi for neurosurgical treatment at Rand Clinic. I only use the services of Rand Clinic Pharmacy for all their medical requirements. I never refer these patients to outside pharmacy for any sensitivity testing or monitoring. I have no dealings with Kate Maboko or Sandringhan Gardens Medical Centre,” wrote Dr. Gopal to Malawi consulate general on April 22 2010 in response to an investigative query.

Several such invoices and payments followed—and the health office paid.

In one falsified invoice, Maboko claimed to have carried out an intra-operative drug reaction monitoring on September 7 2009 on one Malawian patient.

Dr. Gopal confirmed the identity of the patient and that he was scheduled for surgical operation on September 9 2009, but Maboko claimed to have rendered the service.

He also said intra-operative drug reaction monitoring is done “while the operation is in progress and done by the operating surgeon and his team.”

And yet, health attaché Mtotha endorsed this service and paid ZAR5 000 (K195 000) to Maboko.

“In another instance, the team [audit] discovered that Ms. Maboko had already been paid the sum of ZAR7 192.21 (K280 000) for second line chemotherapy treatment tests for heamatological drug reactions on a Malawian female patient on February 24 2010 when her doctor, Dr. Mboyi, indicated to the team that the patient was due for her second chemotherapy session on April 26 2010,” reads the audit report in part.

In a letter to the consular general, Dr. Mboyi also said he had neither knowledge nor dealings with Maboko.

The audit team faulted the Malawi health attaché on all these irregularities, including the lack of proper procedures at the health unit of the consulate.

The health office at the consulate also suspected to have been leaking patients’ information to Maboko to help her fake invoices.

The health referral account is largely managed by the Ministry of Health, but because it is manned by diplomats, it is administratively also accountable to the Ministry of Foreign Affairs.

Foreign Affairs Principal Secretary Patrick Kabambe was yet to respond to our e-mail.