Gauteng health collects over R500m from RAF claims

According to the department, the collection service is based on risk and is commission-based.

Acting Gauteng Health MEC, Jacob Mamabolo, has praised the Gauteng Department of Health (GDOH) for the strides it has made in supplier medical claims recoveries from the Road Accident Fund (RAF) over the past three years.

“Our ability to successfully lodge medical supplier claims has a bearing on whether we are able to sustain our services to people that fall victim to road accidents, hence it is important that attention is paid to [this] area of work,” Mamabolo said in a statement on Monday.

This comes after the department recorded an increase in the collection of revenue, which amounted to a total collection of over R523 million from RAF claims for the period under review.

Mamabolo reflected on this progress in a meeting with Batsumi Claims Management Solution – the service provider tasked with assisting the department with the “complex nature” of administering, processing, and recovering claims from the RAF in respect of medical supplier claims.

“The process to collect from [the] RAF is quite involved. It requires visiting and analysing the accident scene, compiling official accident reports, and statements from witnesses in case of multiple accidents, amongst others.

“The department has no in-house skills to do such work,” Mamabolo explained.

The GDOH submits a claim to the RAF to recover the costs incurred after it has treated a road accident victim.

According to the department, the collection service is based on risk and is commission-based.

“The GDOH only pays the service provider on an agreed commission rate which is only paid once the recoveries have been received by the GDOH and from that the company has been able to claim from RAF after meeting their stringent claims criteria,” spokesperson Kwara Kekana added.

In addition, from the RAF claims over the past three financial years, Batsumi was paid 18% commission when accrual payments were excluded.

Therefore from the rounded-off figure of R523 million collected in revenue over the past three years, Batsumi was paid roughly R146 million.

“MEC Mamabolo pointed out that given the fact that Gauteng is South Africa’s economic hub and it boasts some of the largest road networks in the continent, there is a high volume of cars on our roads traveling within the country and into other parts of the continent.

“This results in road accidents in which people require medical attention through the province’s healthcare system,” Kekana concluded.