A 41 year old pharmacist from Malamulele has been sentenced to 10 years in prison or a R500,000 fine after being found guilty of medical aid fraud involving the Government Employees Medical Scheme (GEMS). The sentence was handed down by the Giyani Specialised Commercial Crime Court following an investigation by the South African Police Service (SAPS) Commercial Crime Unit in Limpopo.
Fraud carried out using members’ details
According to police, the accused, Tinyiko Gift Mongolele, is the director of a pharmacy in Malamulele. He was convicted on 18 counts of fraud after submitting false medical aid claims using personal information obtained from GEMS members.
Investigators found that he approached members and asked for their medical aid details, offering cash back incentives or shoes in return. He then allegedly used the information to submit claims for medication.
In some cases, he used the details of two doctors without their knowledge or consent. Police say certain members had never consulted the doctors and were unaware that claims had been made in their names.
Financial loss to GEMS
The fraudulent activities took place between January and September 2018. During this period, GEMS suffered losses totalling R91,873.07.
The case was opened after the medical scheme detected suspicious claims linked to its members.
Arrest and court proceedings
Mongolele was arrested on 12 May 2025 and appeared in the Malamulele Magistrate’s Court the same day, where he was granted bail of R5,000. He later appeared in the Specialised Commercial Crime Court in Giyani, where he was convicted and sentenced on 17 February 2025.
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