HOW DO MEDICAL AID SCHEMES OPERATE? - JUDGE

MBABANE – Do medical service providers have contractual obligations with the Swaziland Medical Aid Fund (SwaziMed)?

This question came up yesterday when Judge Sipho Nkosi heard the matter of the doctor who has taken SwaziMed to court for allegedly suspending him for overutilisation of services.

Dr Tshibungu Jean Pierre Lukoji is also accused of defrauding SwaziMed a sum of E1.3 million. He is one of the medical practitioners who were suspended from receiving direct payment from the fund.
According to SwaziMed, the decision to suspend Dr Lukoji was adequate and proportionate to protect not only his patients but the scheme in general.

The doctor, who is represented by Thulani Sibandze of Rodrigues and Associates, is challenging the decision to suspend him on the grounds that he was not accorded due process.
Judge Nkosi wanted to know from Sibandze why he says he was not afforded due process. Sibandze said Dr Lukoji was only invited to a meeting on March 8, to give an explanation on concerns regarding overutilisation of services.

The judge asked the doctor what he expected to undergo in order to be said he was accorded due process. His representative said he should have been given notice in writing, advised of his rights, served with the charges among other things, to prepare for the hearing.
It was then that Judge Nkosi sought to find out what obligation SwaziMed had to provide all of that.

“What is the nature of relationship between the applicant (doctor) and SwaziMed that he should be afforded the due process as you outlined? Why would SwaziMed owe him that obligation to charge him formally?” Judge Nkosi questioned.

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