Medscheme welcomes landmark healthcare fraud conviction

Johannesburg - Medscheme, a leading healthcare administration company within the AfroCentric Group, welcomes the sentencing of Mr. Lesiba Morgan Gololo, a speech therapist and audiologist, who was yesterday sentenced on four counts of fraud related to false claims submitted to medical schemes. The sentencing, handed down at the Specialised Commercial Crimes Court in Polokwane, marks the culmination of a six-year investigation led by Medscheme’s Group Forensics team in collaboration with law enforcement.

Mr Gololo was sentenced to a R150,000 fine or eight years’ direct imprisonment, a significant outcome in the fight against fraud, waste, and abuse (FWA) in South Africa’s healthcare sector. The case dates back to 2016 and involves fraudulent claims amounting to millions of rands.

The conviction marks Medscheme’s commitment to building a winning health offering by investing in data, digital platforms, and technology to detect and prevent fraud, waste and abuse (FWA). Fraudulent activities cost the South African healthcare industry an estimated R22 billion annually, diverting critical resources from patient care and driving up costs for medical schemes and members.

"This conviction is a testament to the perseverance of our forensic and legal teams, who have worked tirelessly to hold fraudsters accountable. Fraud in healthcare is not a victimless crime—it erodes trust and deprives patients of much-needed resources. Our investment in advanced forensic capabilities and collaboration with law enforcement ensures we can protect the integrity of the healthcare system," said Gerda Strydom, General Manager of AfroCentric Group Forensics.

Andrew Schwulst, CEO of Medscheme, added: "This case aligns with our strategic objectives to leverage technology and data analytics in rooting out fraud. Our digital platforms enable real-time monitoring and detection of irregular claims, ensuring we stay ahead of evolving fraudulent schemes. We remain committed to working with schemes, regulators, and industry bodies to create a sustainable healthcare ecosystem."

Key Details of the Case

• 2016–2023 - Multiple investigations uncovered fraudulent billing practices, including false claims and intimidation tactics against Medscheme staff.
• 2019 - Criminal case was lodged, and the Health Professions Council of South Africa (HPCSA) found Gololo guilty of unprofessional conduct following a case lodged to them.
• 2023: Additional charges were filed, leading to his arrest in December 2023.
• 25 March 2025 - Sentencing delivered in Polokwane.

This conviction highlights the critical importance of collaboration between medical schemes, law enforcement, and the private sector in combating healthcare fraud. The successful prosecution was made possible through close cooperation with Schemes, private sector, the South African Police Service (SAPS), and the Specialised Commercial Crimes Court.

"It's profoundly counterproductive - while we're working tirelessly to make healthcare more accessible and affordable, fraud creates exactly the opposite effect. Every rand stolen through FWA is a rand that could have improved someone's access to care. As Medscheme, we're determined to root out these harmful practices that make healthcare less accessible and more expensive for all South Africans," concludes Schwulst.

Looking Ahead Medscheme will continue to:

• Expand its AI-driven fraud detection systems,
• Strengthen partnerships with schemes, law enforcement, and the HPCSA,
• Advocate for stricter enforcement and policy reforms to combat FWA.