A whistle-blower came forward last week with explosive allegations that six Mediclinic hospitals in Gauteng and the Western Cape have been manipulating patients' bills to save the hospital group money.

The Council for Medical Schemes has sounded the alarm that as the medical schemes regulator, it is "deeply concerned and disturbed by the allegations of billing and other fraudulent activities levelled against hospital group Mediclinic".

Although the council has not yet received a formal complaint, it noted that the allegations in recent media reports are viewed in a serious light. As per various media, including News24, eNCA and Radio 702, a whistle-blower came forward last week with explosive allegations that six Mediclinic hospitals in Gauteng and the Western Cape have been manipulating patients' bills to save the hospital group money. The whistle-blower forwarded the claims to Mediclinic management, News24 and several medical schemes.

When hospitals submit medical bills to medical schemes for payment, they have to submit an ICD-10 code, which varies depending on the procedures carried out or the medication administered.

The whistle-blower, apparently a former manager who worked at the six hospitals, told News24 that, for example, "When a patient died in a hospital emergency room, sometimes Mediclinic case managers were expected to change their accounts to reflect an ICU death instead. This is because of the fixed fees associated with emergency room deaths, which...