Physiotherapists are being left “fearful, stigmatised and traumatised” by medical aid forensic audits that are meant to protect patients’ money, a University of Pretoria (UP) study has found.
The research, conducted by Lesley Meyer, an extraordinary lecturer at UP’s department of physiotherapy, revealed that while audits are designed to detect billing irregularities, many practitioners experience them as unfair, aggressive and damaging, often without proof of guilt.
Published in the South African Journal of Physiotherapy, the study explored the lived experiences of 14 physiotherapists who have undergone forensic audits. It found that these processes are frequently experienced as “punitive and harmful to practitioners rather than corrective”.
Physiotherapists interviewed for the study described the audits as deeply distressing.
“Participants reported feeling unfairly targeted and singled out, describing the audit process as unfairly conducted. Many felt they were subjected to a witch hunt,” said Meyer.
Some said they were treated like criminals from the outset, reporting that they were “locked up in rooms, shouted at, forced to say that they were guilty”.
The study highlights concerns about how audits are carried out. Although medical schemes are allowed to investigate billing inconsistencies, cases involving large sums should be referred to external bodies such as the Health Professions Council of South Africa (HPCSA) or the police.
However, researchers found that schemes sometimes avoid this by classifying suspected fraud as administrative errors, allowing them to handle investigations internally. This creates what the study describes as a “loophole” that enables “misuse, coercive practices and a lack of accountability”.
One of the most troubling aspects is the pressure placed on practitioners to sign Admission of Debt (AOD) agreements. These agreements require physiotherapists to admit guilt and repay money, often under financial pressure.
“For those who sign the AOD, it means they’re admitting that they’re guilty, which is against the Health Professions Act, because if you are guilty, it means you’ve committed fraud, and you can lose your licence. But participants felt like they didn’t have a choice, because they weren’t getting any money from the schemes,” said Meyer.
Participants said they were often forced to choose between signing the agreement or facing blocked payments that could cripple their practices. In some cases, payments were withheld for long periods, pushing practices into financial distress.
The amounts involved ranged from R54,000 to R4.5m.
The study also points to outdated systems as a key part of the problem. Billing codes used by physiotherapists have not been updated since 2006, making it difficult to accurately bill for modern treatments. As a result, practitioners may appear to be overbilling or making errors when they are simply trying to adapt outdated codes to current medical practices.
Beyond administrative issues, the emotional toll on physiotherapists is severe.
One participant said, “Seven months of watching my father die was easier than this experience.”
Others described feeling “helpless, frustrated, very despondent” and said the process was consuming everything.
The study found that distress caused by audits can affect both practitioners’ well-being and their ability to provide care to patients.
Financial strain was another major concern. Some physiotherapists reported legal costs of hundreds of thousands of rand, while others said their practices were pushed to the brink of closure.
“We know many of our single colleagues; it was much harder. It almost destroyed their lives,” said one participant.
Researchers warn that these pressures could drive skilled practitioners out of private practice, reducing access to care for patients.
The study calls for urgent reforms, including clearer rules, updated billing systems and independent oversight of audit processes.
A recent independent legal review into audit practices has already confirmed many of the concerns raised, including lack of transparency and potential misuse of power. However, Meyer stressed that more needs to be done to restore trust.
While audits remain necessary, her research showed the way they are conducted may be harming both healthcare professionals and the system meant to protect patients.
“The people I interviewed were not trying to avoid accountability. They wanted fairness. They wanted to be heard.”
TimesLIVE
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