By Staff Reporter
One of Zimbabwe’s biggest medical aid societies, CIMAS has discontinued its drug facility owing to alleged fraudulent activities by some pharmacies and members. The move was taken in order to determine the extent of the rot and also to ensure that the society does not continue to lose money.
However some of the society’s members have cried foul accusing the medical aid society of unnecessarily inconveniencing them. They complain that they now have to pay for drugs using cash and then claim from the society which is an inconvenience because sometimes they do not have the cash due to difficult economic conditions.
Patience Chitiyo a member of the society said some of them did not have money to pay for the drugs and the CIMAS clinics are always overcrowded making it difficult to access drugs.
But the medical aid society has defended itself saying the old system was only introduced to make the process convenient for members and now that it has emerged that some pharmacies and members were abusing the online claim system to submit fraudulent claims, the society had found it prudent to revert to the system of asking members to submit claims in writing before any payments are made.
Pharmacies have been accused of inflating drug prices and also engaging in claims fraud. This has resulted in the medical aid society losing close to $2 million dollars and threatening the ability of the society to continue offering services to its members.
‘We discovered that pharmacies have been neglecting their ‘gate keepers’ role and selling drugs to people who are not even card holders’ said Rodrick Takawira Managing Director of Medical Aid at CIMAS
‘One of the few honest pharmacies alerted us when they realised that a woman wanted to buy drugs using another person’s membership card. When quizzed why she was using another person’s card and prescription she bolted out’ he said
Takawira added ‘The same woman attempted to do the same again at another pharmacy and when her bag was searched she was found to have 15 other membership cards and had bought drugs worth $300 using these cards. It was at this point that we discovered we had a problem’
According to investigations carried out by the society pharmacies are also inflating prices of drugs and conniving with members to include on claims over the counter drugs that should be paid for using cash. The pharmacies then put in other codes of prescribed drugs and claim from CIMAS.
Despite the society’s membership declining from 204 000 members to 201 000 members and prices of most drugs almost falling by half , the medical aid society discovered that their bill for drugs alone had risen from $1, 7 million to $3,4 million. This is unusual and pointed towards underhand dealings by the pharmacies.
In another case of suspected fraud in Marondera, a pharmacy had 101 members it was servicing and its drug bill was $1200 but a year later the same pharmacy now had 303 members but its drug bill to CIMAS has jumped to $9000.
‘We obviously realised that pharmacies where abusing our online claim system to make inflated or fraudlent claims so we discontinued it to protect the society. We have since asked the software developer to develop a more secure system’ said Roderick Takawira.
He bemoaned that members no longer understood the concept of society as they did not bother to report the pharmacies involved in this rot. He however said that once their internal investigations have been completed the report will be forwarded to the police.
‘Members obviously receive text messages on their phones alerting them of the services they would have accessed from the pharmacies. Despite seeing that the amount reflected on the sms would be different to the ones on their receipt none of them bothered to contact CIMAS to report the anomalies.’ he added.
The online system was created for the convenience of members but the discoveries that it is insecure means members would have to fork out cash to buy drugs and then submit claim forms to the society which would be processed in a month. He urged those that do not have money to obtain drugs from the CIMAS clinics until a solution to plug leakages had been found.
These practices by pharmacies have bought attention on the mushrooming retail pharmacies around the country. Most of these pharmacies are owned by individuals who are only concerned about making more sales to increase their profits. This has a moral hazard and encourages rent seeking behaviour from pharmacists who are concerned about survival and profits.
However a pharmacist in down town Harare who refused to be named refuted the allegations that the pharmacies where stealing from CIMAS. “They must fix their inefficiencies rather than deflect the blame on pharmacies. I can’t speak for others but here we do not do that”
‘Some of us actually insist on CIMAS members paying cash upfront because the medical aid society has been paying us late. Those responsible must probe what is going on at CIMAS” he added.
The situation has been blamed on the law which stipulates that every pharmacy must be 51 % owned by the resident pharmacist. This gives the pharmacists an incentive to grow their sales and some of them are doing this by defrauding medical aid societies.
Those who are supposed to be ensuring that pharmacists adhere to a high ethical code of conduct are neglecting their duties. The actions of the pharmacies are a threat to the well being of medical aid schemes and could throw the health sector into a crisis if the matter is not addressed.
Government must take action to ensure that pharmacies are operated ethically and in accordance with the law. Reports that pharmacies are selling drugs to individuals who do not have doctors’ prescriptions is only a tip of the iceberg of the corruption that may be going on in these pharmacies.