SPEECH THERAPIST Inc

S B MGWENYA

SPEECH THERAPIST Inc.

B. Sp-Lang Path (UKZN)

Pr no: 0724378

Cell: 0720320535

Email:

Unit #43 P O Box 341

Plaza 10 Building Sonpark, 1206

52 Brown Street

Nelspruit ,1200 Tel: 0137522963

Re: Appeal of payments to my practice

Dear Anita

I write this letter directed to you to raise some of the fairness I was getting from one of the forensic Analyst, Ms Shaw, I direct it into you because I believe you are the next person in her office and you might understand the reasons I feel my rights were undermined.

I will also start from the beginning of this issue. On the 1st of February 2018 I received a letter from MsElize Lubbe requesting clarity on the matter of two practice which is my old solo practice Pr 055477 and my Group Practice ( Incorporated Practice )Pr no 0724378, I then then responded by explaining why still both Practice numbers are active, my response was , Initially I registered a solo Practice which is SB Mgwenya pr no 0550477 and this year I opened a group practice SB Mgwenya Speech Therapist Inc Pr no 0724378 and i'm moving in a direction to use group practice .And she acknowledged the clarity.

On the 23 of March 2018 I again received another two letters from Ms. Shaw, informing about a retrospective claims audit against my Practice. This two letters were also forwarded to you. This letters requested me to clarify number of issues regarding my practice, I also responded as follows :

Dear Ms Shaw

This letter serves to appeal the decision taken on my practice, of not making payments to my practice. There are many reasons why I feel the audit you conducted was not done in a proper manner and that led you to take a wrong decision without considering some facts.

In the letter dated 23 March 2018, you wrote that there were irregularities in my claims regarding the number of claims I made in a space of 24 hours. Firstly, when you were doing this audit or investigation, I was never consulted and given an opportunity to explain the operating hours of my practice and the number of therapists that are in my practice. Instead, you quickly concluded that we should have a maximum of 4 hours to attend to Medscheme patients.

It is not under any law that we can only claim 4 hours of Medscheme patients. What do you suggest we do when the patients are referred to us? Is it fair for us to tell the patients to go home and come back the following day because we can only see the Medscheme patients for a maximum of 4 hours in a day?

You were supposed to consult me when conducting your investigation/audit before coming with a verdict. I will therefore clarify how my practice operates. In my practice we attend to both inpatients and outpatients on a daily basis. It is situated in a busy area in Nelspruit CBD. In Nelspruit there are 3 private hospitals where we see the inpatients. We can start as early as 05h00 to prepare the newborns for feeding and can also see patients after 18h00 because those are admitted patients.

I started the practice as a solo practitioner and I had to employ locums incase the workload increases. Currently we are running this practice with three (3) speech therapists to ensure that we share the workload.

In the very same letter you raised a concern about how having two practice numbers and also said one patient was billed with both practice numbers in one session. And you concluded that it was wrong, whereas in the email received from MsElize Lubbe asking about multiple practice numbers, I clarified the issue and explained that I started the practice as solo and now because of growth, I had to change the status and register a Group practice which is the 0724378 practice. I do not see any crime committed if I register an incorporated practice with Medscheme or the crime that I committed is to be located in a busy area and market my practice for many patients to come?

In the issue of us billing one patient with both practice numbers for one session, can I please request details of the patient and date of service to also double check it.

In the Erroneous payment made and the recovery strategy by the schemes: it has come to my attention that a number of schemes ( Nedgroup Medical Aid, Polmed, SABC Medical scheme, Sasolmed , Samwumed and Bonitas) made payments to my practice and I have to pay back to them, Medscheme has been holding my claims for the past two months and some of the money written is the money that I claimed and not received as payment because all of my payment are blocked. I have the following questions:

-Firstly, should I pay back the money I claimed though it not was not paid to my account? That would mean a double lose for my practice.

-Secondly, my other concern is that if I have to pay back the very same amount I charged because of the services provided, that will mean I have provided service for free unless the administrator tells me how much we must charge for our services.

In the very same letter dated 23/03/2018 it is stated that “as a result of anomalous claims and identified irregularities, payments to my practice will be suspended with immediate effect “. But what I do not understand is that this verdict came before 23/03/18 because my claims were suspended two months ago while the issue was still an allegation. I feel like I was found guilty before an audit and/or investigation was conducted.

In conclusion, I want to request that all the information provided about the number of speech therapist in my practice and the operating times as mentioned that the 08h00 – 18h00 applies to outpatients only, but in hospital patients can be attended as early as 05h00 or even after 18h00 depending on our schedules to be considered. The clarity about the practice numbers must also be acknowledge because every business must grow and I doubt Medscheme is against growth.

I plead with you to release my payments and advice for future claims to avoid misunderstanding after taking into consideration the above-mentioned reasons and concerns.

Hope my appeal will reach your favorable consideration

Kind Regards

Mr S B Mgwenya

Managing Director and Speech Therapist

Still in this letter Ms. Shaw noticed that I have not done wrong but she further showed level of desperation to find me wrong even where I was not wrong. She sent another email requested written proof. the email was as follows:

Good day,

We hereby acknowledge receipt of your email and letter attached below and advise the following:

1.When we collated the information to calculate the total hours claimed per day, we included all the Schemes administrated by Medscheme, Samwumed, Discovery, GEMS and Sizwe. We therefore take into consideration the number of hours claimed for, including the above administrators, when calculating the allowed 4 hours for Medscheme Schemes only. This is a reasonable calculation, as claim information were received that confirms claims were processed for the same treatment dates from the other administrators. This calculation also excludes administrators for schemes that we did not receive claims information from, e.g. Medshield.

2.You indicate that your working hours is from 05h00 to 18h00, a 13 hour work day, the collation of the claims (including all administrators advised above) however indicate days where the time based tariff codes accumulate working hours exceeding the above 13 hours. The maximum, as per our letter, being 23.67 hours for the 24/05/2017. A total of 90 days indicate more than 13 hours claimed. You also stipulate that certain days consist of a 10 hour day only.

3.You advised that you employ 3 locums, please forward us their names and practice numbers and the period that they have been employed by you. Further note that locums are employed on a temporary basis and should not assist for more than a period of 6 months. Locums should assist with patients on a temporary basis and cannot service patient permanently. If you wish for a practitioner to assist you with your patients you should register them as a partner.Alternatively the other registered practitioners should claim for services rendered on their own solo practice numbers.

4.We can understand the need to have two practice numbers if you have two premises, however as per our Section 59 letters, the registration of another practice number for the same premises does not follow good corporate governance and can result in duplication of claims for patients treated. Please ensure future claims are processed on only one practice number.

5.The duplicate claims referred to was for a Sasolmed member, M D Ngomane (88100605987) for the treatment dates on the 05/02/2018 and the 12/02/2018. Both treatment dates were claimed for on both practice numbers.

6.The monies that are currently on withhold for your practice will be used to offset the amounts owing to the schemes as advised in the Section 59 letters. Any outstanding payments will be deducted from future claims forwarded for processing.Alternatively a pay arrangement or Acknowledgement of Debt can be signed or agreed on to settle the outstanding amounts.

After this email I called her still trying to clarify the matter she seems to understand through our telephone conversation and she then the email below:

Good day,

As per our discussion today, please forward the following information regarding the locums/employees that worked for you from 01 March 2016 to 28/02/2018:

-Period of employment:

oIndicate each period, if employed more than once.

-Hours working per day (average) if temporary.

-Signed agreement locum or contract of employment if permanent.

-Approved RWOPS if working in Public Sector.

-Advise registration number for those locums not previously forwarded.

Further information will follow regarding the employment of staff under a solo practice.

With this email I was even forced to provide private and confidential contract between myself and the people who helps me, I felt also my rights and my partners rights were violeted trying to prove innocence in this matter. I was the told that there’s request made with SASLHA about the audit :

On 10 Apr 2018, at 10:50, Dorothy Shaw <> wrote:

Good day,

Please note that we have requested clarify on a number of issues from the South African Speech-Language-Hearing Association, regarding your audit. Feedback will be provided to your practice once we’ve received written feedback from the Association.

Regards

Hi Dorothy Shaw

With due respect , I would like to know the reason behind for querying my audit with SASHLA. And i’m starting to notice some delaying tactics , you’ve been taking me from one pillar to another and I have provided all documents you requested .

What i’m noting here is that you are trying hard to find case in me so you won’t pay me my money. Is it because i owned a successful black owned practice and you think it impossible to do right.

There are number of Associations of Speech Therapist in South Africa but why did you choose SASHLA not NABSLHA?

Can you also take my work serious and understand that I’m also running a business here.

Regards

SabeloMgwenya

After this email she sent an email abstracting rules that she misinterpreted and used her judgement as final judgement. The email she sent was as follows:

Good day,

We have received formal feedback from the HPSCA and the Association and I am in the process of compiling formal written feedback to you. Please note that your practice was selected for audit due to the increase in claims over the last 2 years and with the registration of the 2nd practice number.

You advised that the two Speech Therapists working for you have been employed permanently, however the contract forward advise a temporary 1 year contract, temporary employment is still classified as a locum.

The below information was received from the HPCSA regarding locums:

HPCSA: Rules concerning locums

Resource

Booklet 2 of the ethical booklets.

Herewith an extract from the Ethical and professional rules of the Health Professions Council of South Africa as promulgated in Government Gazette R717/2006 promulgated by the Minister of Health

Covering

(a) who is registered under the Act to practise in independent practice;

(b) whose name currently appears on the register kept by the registrar in terms of section 18 of the Act; and

(2) A practitioner shall help or support only a person registered under the Act, the Pharmacy Act, 1974 (Act No. 53 of 1974), the Nursing Act, 1978 (Act No. 50 of 1978), the Social Service Professions Act, 1978 (Act No. 110 of 1978), the Dental Technicians Act, 1979 (Act No. 19 of 1979), or the Allied Health Professions Act, 1982 (Act No. 63 of 1982), if the professional practice or conduct of such person is legal and within the scope of his or her profession.

Rules concerning the employment for a period not exceeding 6 months

Resource: Dr MunyadziwakKwinda: Acting COO HPCSA .Dated 9th April 2018

Additional note received: An extension of the 6 month contract period should not be allowed. The period for the locum is limited to six months and the contract should come to an end...not sign a new contract as this will defeat the purpose of the Rule.

The HPCSA – Guideline on Over Servicing, Perverse Incentives and Related Matters, also refers. Point 3.10 Charging or Receiving Fees (page 8)

3.10.3 For services not personally rendered:

Health care practitioners shall not charge or receive fees for services not personally

rendered by either a health care professional himself or herself or by an unregistered

person in his or her employ, except for services rendered by another health care

practitioner or person registered in terms of the Health Professions Act (Act No. 56 of

1974), that regulates the particular profession, with whom the health care practitioner is

associated as a partner, shareholder or locum tenens.

The above therefore advises that if you wish to employ someone permanently in your practice you need to register the additional Therapist as partners of your practice, this should be done through BHF who will forward the information to us to update our systems.

As advised I am in the process of drafting a formal letter for you and will send this to you tomorrow. Some of the above information will be repeated in the letter, I am however including the full feedback received and information required regarding the employment of locums.

Regards

After noticing that all these rules are clear but Ms. Shaw decided to apply it properly and she ended up misinterpreting it, I wrote a letter responding to it but she ignored the letter.find my letter below:

Dear Ms Shaw

I want to inform you that I have received your email sent on the 10th of April 2018. I also want to inform you that I have noted the effort and desperation to ensure that you find wrong in my case, it is also noted that since I have been giving you all the information you have been requesting and not able to find something to discredit my name and my Practice. The level of desperation to find wrong and gain money from my work has made you not to follow correct laws and also misrepresenting some of the rules outlined in HPCSA and BHF.

I have noted the rule you have abstracted from HPCSA booklet 2 and I think it will be better to assist in interpretation of the rules. The first rule that I have noted misinterpretation was :

Covering

9. (1) A practitioner shall employ as a professional assistant or locum tenens, or in any other contractual capacity and, in the case of locum tenens for a period not exceeding six months, only a person - (a) who is registered under the Act to practise in independent practice; (b) whose name currently appears on the register kept by the registrar in terms of section 18 of the Act; and (c) who is not suspended from practising his or her profession.

It talks about who must assist a practitioner in doing his/her job, it explained that “ A practitioner shall employ as a professional assistant or locum tenens, or in any other contractual capacity …”

With the above quote it means as a practitioner, I have a right to employ a professional assistant in a contractual basis.

Another area touched which you have concluded without understanding it is this issue of a locum, it states that “… and, in the case of locum tenens for a period not exceeding six months, only a person - (a) who is registered under the Act to practise in independent practice; (b) whose name currently appears on the register kept by the registrar in terms of section 18 of the Act; and (c) who is not suspended from practising his or her profession”