NIS to review medical slips from claims scam
Stabroek News
June 5, 2004
The management of the NIS has taken a decision to review all medical certificates that a doctor in Berbice issued in an apparent attempt to defraud the scheme.
In a release issued yesterday, National Insurance Scheme (NIS) Public Relations Officer, Debra Carter said the process would involve validating the diagnosis and medical condition stated on the certificates. She said all the contributors who submitted claims from the doctor and those whose medicals are deemed to be suspicious during the review would be subject to a medical examination. The due process of disallowing benefits and the right to appeal will be allowed in those cases that merit consideration, Carter said.
The irregularities were unearthed in East and West Berbice involving a number of sugar workers and a doctor stationed at the New Amsterdam Hospital.
Reports are that the scam involved some 200 sickness benefit claims submitted by cane harvesters attached to the Guyana Sugar Corporation (GUYSUCO), 53 of which were approved by the doctor.
Carter said NIS officers in various Berbice locations are gathering and sorting the suspicious claims for review and that officials of the Ministry of Health are collaborating with the NIS on how the cases should be treated. She said measures have been put in place to guarantee the integrity of the medical certificates being issued.
Carter stressed that the NIS management is very concerned: "Medical certificates should only be issued to persons who satisfy conditions of sickness or injury. The fact that certain workers of Guysuco sought to replace income due to out-of- crop activities affecting their employment is not a valid reason to claim illness and the medical officers who play an important part in the process of NIS paying [benefits] are expected to uphold the high tenets of their professional integrity," Carter said.
Reports are that the same practitioner issued 33 claims from the Fort Wellington Hospital, West Coast Berbice and a similar number from the Port Mourant Hospital.