How using Med EDI can get you into trouble

Realtime World of MedEDI not what it seems

Many doctors have been sold on the benefits of so-called realtime claim submission.

But does it really improve efficiency and profitability in medical practices? And at what personal risk to the doctor?

Here’s why submitting claims without first reviewing them is a bad idea. Check out this intriguing tale from Medical Briefs involving a surgeon, Metropolitan Health Group (MHG), Government Employees Medical Scheme (GEMS) and Medical EDI Services (MedEDI).

Retired surgeon and former medical school dean must repay R7m medical aid error

The Grahamstown High Court has ordered a retired Mthatha surgeon and former medical school dean, to repay the R7m mistakenly put into his bank account by Metropolitan Health, reports the Daily Dispatch.

Professor Lizo Mazwai, who is also a former long-serving dean of Walter Sisulu Universitymedical school, fought tooth and nail in court against paying back the money toMetropolitan Health, saying he had blown the bulk of it as he had believed it to be a legitimate pension payout. But he will now have to find a way to pay back Metropolitan Health some R7.08m plus interest of 9.5% backdated to January last year.

Acting Judge Nicola RedpathMolony also ordered him to pay all the legal costs of the application, including what is likely to be a hefty bill from senior counsel advocate Chris Eloff, who argued the matter on behalf of Metropolitan Health. He will also have to pay his own legal team, which included senior counsel advocate Dali Mpofu.

The report says according to court papers, Mazwai’s account administrators, Medical EDI Services, which assists doctors to submit claims to medical aids, filled in an incorrect amount in what was termed the software’s “multiplier column”. So instead of claiming for one operation at a cost of R, 800, it had claimed for 2,469 operations at that price. The result was a hefty bill of more than R7m being submitted to Metropolitan Health, which administers claims on behalf of the Government Employees Medical Scheme (Gems).

Metropolitan’s computer software had not picked up anything odd and it had approved the payment. Gems had duly paid Mazwai. Mazwai used the “windfall” to pay off debts and make various investments. There was only R2.5m left which he had put into an interest-bearing trust account with his attorney.

The report says he had refused to pay even the remaining amount to Metropolitan Health. He questioned Metropolitan Health’s standing to come to court to claim the money back when it was technically Gems that had paid him out the amount.

But acting judge Redpath-Molony said it was clear that Metropolitan Health had paid Gems out for the mistake it had made and Gems had, in turn, legally ceded its claim against Mazwai to Metropolitan Health. She also dismissed Mazwai’s claim that the money must have been put into his account as part of a money laundering scheme.

 

Full story here

This is why we believe in honest Medical Billing and Claims performed by a properly trained staff member, with our Medinol software as the only way to go … proven effectiveness in serving medical doctors for 30+ years.

 



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About Medinol:
Medinol is one of the few purpose-built practice management application to meet the unique needs of independent private healthcare providers. Today Medinol helps over 130 providers throughout South Africa run more efficient and profitable practices, while delivering outstanding patient care. As an on-premise software, Medinol and the data it manages, is fully under your control. This enhances your independence and privacy:¬†what happens in your rooms, stays in your rooms. Medinol helps manage your patient information, generates your billings, submits your claims, control your outstandings, and get your accounts paid quickly. Medinol has been in operation since 1984 demonstrating its proven efficacy. Medinol’s mission is to help independent practices succeed in an ever-changing healthcare environment. More information can be found at http://medinol.co.za.

Contact:
Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610

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