Medical aid firms deny discrimination
JOHANNESBURG - DISCOVERY and Afrocentric yesterday shrugged off damning findings against medical aid schemes in South Africa, firming 1.78 percent and 11.94 percent to R142.79 and R4.50 respectively, as a report unveiled series of discriminatory practices against them.
The listed schemes strengthened, despite an investigation by the Council for Medical Schemes (CMS) that flagged South Africa’s three largest medical aid administrators for racially discriminating against black doctors for at least eight years.
The CMS Interim Report found that Discovery, Medscheme and the Government Employees Medical Scheme (GEMS) unfairly discriminated against black, Indian and coloured medical providers on the grounds of race.
The inquiry, known as Section 59 Investigation Panel, was launched in 2019, after a number of healthcare providers made allegations of unfair treatment by medical aid schemes based on race and ethnicity.
In the complaint, the National Health Care Professionals Association (NHCPA) and Solutionist Thinkers claimed that the medical aid administrators were withholding payments to their members and that affected their businesses bottom line.
In his testimony, NHPCPA president Dr Tebogo Kgosietsile Letlape argued that mechanisms used by medical schemes to address fraud, waste and abuse (FWA) only affected black doctors, because they were dependent on the direct payment from medical aids.
Chair of the panel, Advocate Tembeka Ngcukaitobi, said that between 2012 and 2019, black medical practitioners were more likely to be found to have committed FWA than their nonblack (white) counterparts by these medical schemes.
Ngcukaitobi said black medical practitioners across all disciplines were 1.4 times more likely to be classified as having committed FWA than those identified as not black over this period.
However, Ngcukaitobi said the scale of racial discrimination differed from scheme-to-scheme and it was not a blanket
“For Discovery, we found that they were 35 percent more likely to identify black providers as having committed fraud, waste and abuse,” he said. “This is the lowest rate of the three schemes and administrators that we looked at. Discovery had the lowest rate of the likelihood of unfair racial discrimination.”
Ngcukaitobi said GEMS was 80 percent more likely to identify black providers as having committed FWA.
“Medscheme, which has the highest likelihood, is 330 percent more likely to identify black providers as having committed fraud, waste and abuse,” Ngcukaitobi said.
“We find the schemes, collectively, likely to identify black providers as having committed fraud, waste and abuse.”
The report said that every scheme and administrator that was implicated in the complaints denied that there was unfair racial discrimination in their FWA investigation process.
Their denials were based on the fact that the FWA investigations are triggered by either an automated system, underpinned by an algorithm, that flags outlier practices for investigation; or tip-offs and whistle-blowers.
The issuing of the report was marred by controversy when GEMS urgently rushed to the court on Sunday to interdict the findings from being made public.
Judge Colleen Collis yesterday delivered her judgment, striking the matter from the roll due to lack of urgency.
Discovery and GEMS did not comment on the findings of the report, but comments can be submitted to the Panel until March 5.
Medscheme – which is owned by Afrocentric Health – said it did not take lightly its duty towards its beneficiaries to validate and verify healthcare claims.
Medscheme executive director Dr Lungi Nyathi rejected claims of racial profiling against the company.
“We are extremely disappointed that we were not afforded the opportunity to review the Interim Report of the Panel before it was published publicly, as has been agreed,” she said.
“We shall now review the contents of the Interim Report and make a formal submission in response thereto.”