KUALA LUMPUR: Intelligence gathered by the Social Security Organisation's (Perkeso) Anti-Fraud, Ethics and Integrity Department has led to the discovery of a sophisticated permanent disability claims cartel.
This comes amid an anti-corruption probe into a fraudulent permanent disability claims cartel involving several doctors that has resulted in more than RM2 million in losses.
Perkeso group chief executive officer Datuk Seri Dr Mohammed Azman Aziz Mohammed said some of the standard operating procedures they would examine included increasing the amount of information required from doctors when submitting claims.
"We are aware that the Socso claims process is quite complex, involving many parties, including professionals such as doctors who provide medical reports, and possibly involving Perkeso officers as well. So the process we are referring to involves enhancing the information we receive from private doctors.
"For instance, in this case, private doctors were involved in creating false reports. Additionally, a panel of doctors was also involved with this cartel to assist in the fraudulent claims.
"Therefore, we may need to improve and increase monitoring at the level of the medical panel. We also need to enhance internal processes as every case that comes to us will be processed as genuine unless proven otherwise," he said at a press conference in Menara Perkeso here yesterday.
He added that the new standard operating procedures would be announced in due course.
More than 30 individuals, including three doctors, were remanded yesterday over their alleged links to a cartel accused of falsifying Perkeso disability claims.
It is understood that the cartel has been active since 2017.
Magistrate Nadratun Naim Mohd Saidi ordered the doctors to be remanded for two days.
This bust was made following an internal investigation by Perkeso's Anti-Fraud, Ethics and Integrity Department earlier this year.
Since July, Perkeso has been working with the Malaysian Anti-Corruption Commission to dismantle the cartel under Op Tunjang.
Perkeso will expand the operation with the MACC and the Health Ministry.
Human Resources Minister Steven Sim, in the same press conference, said he had requested Perkeso to revamp its claim system to eliminate any loophole that could result in false claims.
Dr Mohammed Azman said the claims involved commuting accidents that did not involve any third party for Perkeso to verify.
This includes claims from accidents involving potholes, dogs and slippery floors.
"These are some of the cases that were reported, and they have claimed, for example, that they broke their arm, but they did not.
"When they said they broke their leg, the X-ray showed that it didn't happen. But the full report stated it was broken and they were given a 90-day medical certificate."
MACC Chief Commissioner Tan Sri Azam Baki said two doctors were picked up from government hospitals and one from a private hospital.
He said yesterday that another doctor had been identified and was expected to be arrested by MACC.