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DOCTOR DEFRAUDED US E1.3M - SWAZIMED

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MBABANE – Doctor Tshibungu Jean Pierre Lukoji is alleged to have defrauded SwaziMed over E1.3 million.


He is alleged to have defrauded the scheme (SwaziMed) by submitting volumes of fraudulent claims.
Dr Lukoji is a Specialist Physician of Internal medicine and he operates Smart Clinic at Makhaya Centre in Manzini. This is contained in SwaziMed’s answering papers after the doctor took it to court wherein he is challenging his suspension.


The doctor wants the court to set aside and/or lift his indefinite suspension as a direct payee of the provision of health care and medical services to SwaziMed members.
SwaziMed alleged that during the period of January to December 2016, Dr Lukoji submitted fraudulent claims for folio dresses. A folio dress is a disposable gown worn by a doctor during an operation. In his affidavit, SwaziMed Principal Officer Peter Simelane pointed out that the scheme’s tariff for a folio dress was E185.18 and Dr. Lukoji would allegedly claim E1 122 per operation/procedure.
He said this meant that he was claiming for six or seven gowns for that single operation.


Simelane further stated that apart from the fact that the doctor (Lukoji) was charging for six to seven gowns for one operation, a folio dress was a non-chargeable item for a gastroscopy and endoscopy procedure/operation. He mentioned that a folio dress/gown was only chargeable in the ward for reverse bearer nursing and extensive burns subject to approval by the scheme.


Simelane told the court that notwithstanding the clear rule, Dr Lukoji charged for a folio dress or gown.   He averred that the doctor was clearly defrauding the scheme.
“Dr. Lukoji also submitted and was paid for fraudulent claims in respect of another item, a gel emulsion which is a lubrication jelly or emulsifying jelly.  SwaziMed allows claims for gel emulsion for up E75.10 per 5ml. Dr. Lukoji, meanwhile claimed E6 589.48 for 5ml of gel emulsion,” submitted Simelane.


He claimed that in the process, the doctor defrauded the scheme an amount of E46 126.36. These are allegations whose veracity is yet to be tested in court.
The specialist (Dr. Lukoji) is again accused of having submitted fraudulent claims in respect of biopsy disposable.

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