Fraudulent billing, including charging for services that were not provided, has emerged as the most common form of professional misconduct among registered psychologists in South Africa over the past decade, according to new research, Cape Times reported.
The findings come from an international team of researchers from the United States, the Netherlands and South Africa, including Prof Nico Nortje from the University of the Western Cape’s Department of Dietetics and Nutrition.
According to a report published in the South African Journal of Psychology, the study examined public disciplinary records from the Health Professions Council of South Africa (HPCSA) covering the period 2014 to 2023, with 2019 excluded due to a lack of records.
The researchers found that fraudulent conduct accounted for about 83% of all ethical transgressions recorded against psychologists during the study period.
Gauteng recorded the highest number of cases, accounting for 74.2% of all sanctioned practitioners. The province is home to about 45% of South Africa’s psychologists.
KwaZulu-Natal, which has the third-highest number of registered psychologists at about 12%, recorded 9.6% of transgressions. The Western Cape, with roughly 24% of the country’s psychologists, accounted for 6.2%.
The study also examined whether earlier recommendations aimed at reducing misconduct had made an impact, noting a slight overall decline in the number of transgressions over the study period.
The author team included lead researcher Mila Nortje from Christopher Newport University in the United States, alongside co-authors Yanet Gezu (Duke University and Augustana College), Neela Ravi (Rice University), Dr Maureen Pontarelli (University of Texas), Grace Truong (Skidmore College), Andrew Baldassarre (University of Houston) and Dr Willem Hoffmann, a research ethicist in private practice in the Netherlands.
Researchers also reviewed ethical misconduct among registered counsellors, another group regulated under the broader psychology profession, and found similar patterns.
While fraudulent activity dominated the findings, the researchers cautioned that only a small proportion of psychologists were involved in disciplinary action – 97 out of 8,488 registered practitioners nationally. A total of 178 transgressions were recorded during the study period.
They further noted that the results were heavily influenced by two practitioners who were each found guilty of 57 counts of fraud, together accounting for about 66% of all fraud-related offences in the dataset.
The researchers said this meant the high percentage of fraud should not be interpreted as widespread across the profession.
They also suggested that increased patient awareness and education, particularly in urban areas, may have contributed to more complaints being lodged, which could help explain the concentration of cases in cities.
Other forms of misconduct were significantly less common. Improper professional conduct accounted for 5% of cases, negligence or incompetence in assessment and treatment 3%, unauthorised disclosure of confidential information 2%, and abuse 1%.
In terms of sanctions, the HPCSA most commonly imposed financial penalties ranging from R2,500 to R70,000, accounting for 36% of cases. A further 24% resulted in cautions or cautions with reprimands.
The researchers said the findings offer insight into the types of ethical violations occurring within the profession, as well as how regulators are responding through disciplinary action.
They added that while previous recommendations encouraged psychologists to engage in regular group reflection on ethical issues, the results point to the need for ongoing ethics training and continued efforts to address systemic factors contributing to misconduct.
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