The Giyani Specialized Commercial Crime Court in Limpopo has sentenced a 41-year-old pharmacist to 10 years imprisonment or pay a fine of half a million after he was convicted of 18 charges of fraud on Wednesday, 18 February 2026. 

According to evidence presented to the court in Giyani, the fraudster, Tinyiko Gift Mongolele, approached Government Employees Medical Scheme (GEMS) members in 2018 and requested their medical aid information, promising them cash-back incentives or shoes in return.

He also used the details of two medical doctors without their knowledge or consent to submit claims for medication requiring prescriptions.

In some instances, members had never consulted the doctors concerned and were unaware that claims had been submitted on their behalf.

“A 41-year-old pharmacist, Tinyiko Gift Mongolele, has been sentenced to 10 years imprisonment or a fine of R500 000.00 after being convicted on 18 counts of fraud by the Giyani Specialized Commercial Crime Court.

“The accused, who is the director of ‘a Pharmacy’ in Malamulele, was arrested (in May 2025) following an intensive investigation into fraudulent medical aid claims. The docket was assigned to Warrant Officer Choene Manaka attached to the Provincial Commercial Crime Unit for further investigation. The complainant in this matter is the Government Employees Medical Scheme (GEMS), which opened a case after detecting suspicious claims submitted under members’ details,” said police in a statement. 

In May 2025, African Times reported that Mangolele stood accused of stealing nearly a million rand in GEMS fraud but the National Prosecuting Authority (NPA) in the province has since recalculated the amount to just over R90 thousand. 

Limpopo Police Spokesperson Colonel Malesela Ledwaba confirmed the sentence relating to Mangolele’s nine-month criminal activity.

“As a result of the fraudulent activities committed between January 2018 and September 2018, GEMS suffered a total loss of R91 873.07. The Provincial Commissioner of Police in Limpopo has welcomed the conviction and commended the Provincial Commercial Crime Unit for their thorough investigation and continued efforts to combat fraud and protect public funds,” Ledwaba added. 

According to media reports and police investigations, medical aid scams in South Africa involve various fraudulent practices where individuals or healthcare providers intentionally mislead medical schemes to gain unauthorised financial benefits. 

These scams range from submitting false claims for services never rendered to colluding with doctors and hospitals for inflated admissions. They also include misuse of benefits, such as claiming for non-covered services or using multiple gap cover schemes for the same claim.

Here is a more detailed look at some common types of medical aid scams:

False or Inflated Claims:

• Forging claims: Submitting claims for services that were never provided.
• Collusion with providers: Working with doctors or hospitals to inflate claims for hospital admissions that never occurred.
• Submitting claims for non-covered services: Claiming for services that are not covered by the medical scheme, sometimes using codes that are covered.
• Billing for generic medication as branded: Providing a member with generic medication but charging for the branded version.
• Providing unnecessary services: Offering services that are not medically necessary and claiming for them.

Misuse of Benefits:

• Using a member’s card for unauthorised dependents: Providing benefits to dependents who are not covered by the member’s plan.
• Dual memberships: Attempting to claim from multiple medical schemes for the same services.
• Multiple claims for the same product: Claiming multiple times for the same physical device or product and profiting from the excess.
• Gap cover fraud: Submitting gap cover claims after having paid out of pocket for the same valid claim, and claiming from both the medical scheme and the gap cover provider, or using multiple gap cover schemes for the same claim.

Card Farming:

• Unauthorised use of a member’s card: Providing a member’s card to someone who is not entitled to use it.
• Lending a card to others: Providing a card to others to receive benefits.

Organised Fraud:

• Syndicates: Organised groups that work together to commit medical aid fraud.
• Card farming: Using multiple member cards to claim for the same services.
• Fraudulent medico-legal claims: Submitting claims for medico-legal issues that are false, including false birth injury claims.

Other Types of Fraud:

• Submitting claims for deceased patients: Submitting claims for individuals who have passed away.
• Fraudulent claims in Covid-19 days: Claims that were submitted during Covid-19 days that were later found to be fraudulent.
• Fraudulent billings: Submitting claims with inaccurate codes or information.
• Card farming: Using a member’s card to receive benefits for someone else.