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Author: Thando Maeko
The Section 59 Investigation Panel has found that three medical aid schemes, Discovery Healthcare, Medscheme and the Government Employees Medical Scheme (Gems) have unfairly discriminated against black medical practitioners for eight years.
The Council for Medical Schemes (CMS) launched the Section 59 investigation following a complaint laid by the members of the National Health Care Professionals Association (NHCPA) and Solutionist Thinkers that their members were being racially discriminated against by medical aid schemes and administrators.
The NHCPA claims that unfair discrimination also led to medical aid schemes and administrators withholding payments to their members, which directly impacts the bottom line of their members’ businesses.
This claim was supported by The Health Professions Council of South Africa (HPCSA).
The panel found that between 2012 and 2019, black medical practitioners were 1.4 times more likely than those not identified as black to have been classified by the three medical aid schemes to have committed fraud, waste and abuse (FWA), which amounts to unfair racial discrimination.
The interim report released on Tuesday found that Discovery was 35% more likely to identify black providers as having committed (FWA), Gems 80% and Medscheme 330%.
GEMS
One example of racial profiling provided to the panel by the NHCPA was a ‘Black List’, which is published by Gems. It is a list of providers that patients should no longer consult after being blacklisted for allegedly committing FWA.
Ninety-four per cent of general practitioners and 100% of social workers blacklisted by Gems were black, according to the interim report.
Speaking at the release of the interim report on Tuesday, the panel’s chairperson Advocate Tembeka Ngcukaitobi said that during the public hearings which were held from July 2019 to January 2020 some medical practitioners had complained of “sheer intimidation” by medical schemes, which in turn forced the black medical practitioners to accede to the demands of the medical aid schemes.
Parties have until March 1, 2020, to provide the panel with their views on the interim report before a final report is released.
For the full report, you can visit Moneyweb.co.za
