An investigation by the Council for Medical Schemes (CMS) has found that three medical aid schemes have unfairly discriminated against black medical practitioners in the past eight years.
The investigation was carried out by the Section 59 Investigation Panel, and found that Medscheme, Discovery Healthcare and the Government Employees Medical Aid Scheme (GEMS) were implicated in unfair discrimination against black doctors.
‘Black’ refers to African, coloured and Indian race groups.
The CMS launched the Section 59 investigation after a complaint was laid by members of the National Health Care Professionals Association (NHCPA) that their members were being racially discriminated against by major medical aid schemes and administrators.
According to the NHCPA, this unfair discrimination has also led to medical aid schemes and administrators withholding payments from their members, and this directly – and negatively – impacts the bottom line of their members’ medical practice businesses. This claim was supported by The Health Professions Council of South Africa (HPCSA).
HPCSA president Dr Tebogo Kgosietsile Letlape gave his testimony and said that the mechanisms the schemes have in place to address issues such as fraud, waste and abuse (FWA) only affect black medical service providers, who are dependent on the direct payment of medical aids.
“The people from affluent communities are not affected by these issues. They have, you know, tap machines, swipe machines. You pay before you are seen, or you pay before you leave. They don’t have creditors. They don’t send accounts. And they are not impacted by this behaviour of medical aids,” he said, as reported by Moneyweb.
Between 2012 and 2019, black medical practitioners were 1.4 times more likely to have been classified by the three medical aid schemes to have committed FWA. This is viewed as unfair racial discrimination.
The panel was informed that during FWA investigations, the affected medical practitioners were provided with “minimal communication” regarding the status of the investigations.
“This left providers in a position where they were being asked for information without any context or explanation about what it was the scheme was seeking to verify…. This vagueness made it difficult for the providers to respond,” the report found.
Each scheme and administrator identified in the complaints denied that there was unfair racial discrimination in their FWA investigation process.
The report was released on Tuesday, January 19 when the Gauteng High Court ruled that the interdict to prevent the report from being released by Gems and the Healthcare Funders had to be struck off the roll.
The application by Gems and the Healthcare Funders was heard on Sunday, January 17.
The implicated parties have until March 1 to provide the panel with their views on the interim report before a final report will be released.