Controversial ambulance companies ordered to pay back over R500m to Free State government

Daily Maverick

13-05-2025

The Special Tribunal has ordered four ambulance companies run by Thapelo Buthelezi to pay back more than R500-million. The matter relates to contracts awarded by the Free State government that were first reported on in Spotlight's #Health4Sale series of investigative articles in 2018.
In the order, signed by Judge David Makhoba, Buthelezi One Stop Emergency Med was ordered to pay back R40.6-million, Buthelezi One Stop EMS to pay back R4.7-million, Buthelezi EMS R305.1-million, and B EMS R182.2-million. Together, this amounts to more than R532-million.
The payments from the Free State Department of Health to these companies were declared to be 'unlawful, unprocedural and unconstitutional'. No reasons were given in the order, seen by Spotlight and Daily Maverick.
The Special Tribunal's core function is to recover public funds. It is not empowered to conduct criminal prosecutions, although it can refer matters to the National Prosecuting Authority (NPA).
'Buthelezi and associated companies have been ordered to submit audited statements for expenses incurred, income received and profit made under the unlawful contracts,' said the SIU in a media statement released on Monday. 'Furthermore, the Tribunal ruling, dated 5 May 2025, ordered that Buthelezi pay the legal costs of the application and the SIU's legal representatives.'
Outsourcing ambulance services
As reported by Spotlight in 2018, the Free State Department of Health took the unusual decision to outsource its emergency medical and patient transport services in 2013. The only other province to do so was North West, in which one of Buthelezi's companies also won a large contract. The decision to outsource was particularly puzzling in the Free State as the province's own ambulance service appeared to be doing well at the time.
Besides the questionable decision to outsource, there were several other red flags relating to the contracts in both the Free State and North West. These included whether tenders were appropriately motivated, designed, advertised and adjudicated, and whether health departments were being overcharged once the services started — in North West, Spotlight was shown particularly compelling evidence of systematic overcharging.
At the time, Spotlight identified six companies with names that were variations of Buthelezi EMS — we found instances in which company names on invoices did not correspond to the company registration numbers on the same invoices. Eyebrows were also raised over two back-dated price increases for Buthelezi EMS that were signed off while the province's health department was essentially taken out of administration for five days.
In both the Free State and North West, healthcare workers interviewed by Spotlight reported that the services provided by Buthelezi EMS were not up to scratch. Several Free State doctors alleged that Buthelezi EMS routinely overloaded ambulances and subsequently charged as if the patients were transported separately. Questions were also raised about an alleged lack of equipment on the company's ambulances.
Figures shared by the Free State Department of Health at the time showed that by mid-2018, it had paid Buthelezi EMS more than R1-billion.
After the publication of Spotlight's first two articles on Buthelezi EMS, Health Minister Dr Aaron Motsoaledi told Spotlight in April 2018 that he had asked the National Treasury to investigate the procurement of services from Buthelezi EMS and Mediosa in the Free State and North West.
At the time, the Hawks were also investigating some of the contracts, and the then North West premier, Supra Mahumapelo, had instituted a forensic probe. In June that year, Deputy Health Minister Dr Joe Phaahla told Spotlight that B EMS had overcharged the North West Department of Health by R62-million.
A year later, President Cyril Ramaphosa issued a proclamation empowering the SIU to investigate the contracts with Buthelezi's companies. It is that proclamation that set in motion the series of events leading to this week's order from the Special Tribunal.
Intent to appeal
When Daily Maverick and Spotlight contacted Buthelezi on Monday, he said that he would not be commenting to any journalists at this time since they intended to appeal the tribunal's decision.
Spotlight asked the SIU whether it would refer the matter to the NPA for criminal prosecution. The SIU did not provide a direct answer, but in its media statement said: 'The SIU is empowered to institute a civil action in the High Court or a Special Tribunal to correct any wrongdoing uncovered during investigations caused by corruption, fraud, or maladministration. In line with the Special Investigating Units and Special Tribunals Act 74 of 1996, the SIU refers any evidence pointing to criminal conduct it uncovers to the National Prosecuting Authority (NPA) for further action.'
It is thus not yet clear whether any steps will be taken against the officials in the Free State Department of Health who managed the tender process and signed off the payments that have now been found to be unlawful, unprocedural and unconstitutional.
Buthelezi has also been in court on other matters. In 2022, he appeared in the Bloemfontein Magistrates' Court regarding the alleged failure of his companies to pay tax on about R1-billion in income from the Free State Department of Health from 2014 to 2019. The South African Revenue Service reportedly recovered close to R100-million from the company. Buthelezi also declined to comment when asked about that case. DM