Interim report finds race bias in medical aid scheme fraud investigations

By Zelda Venter Time of article published Jan 19, 2021

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Pretoria - The council for Medical Schemes' investigation into allegations of racial profiling against black and Indian private medical practitioners found that black providers are unfairly discriminated against on the grounds of race.

This is according to a preliminary report issued Tuesday by a panel headed by Advocate Tembeka Ngcukaitobi, who chaired the investigation.

The panel found that some of the current procedures followed by schemes to enforce their rights in terms of the law are unfair.

“These findings are both serious and far-reaching. But we believe that it is important to stress that we have not found evidence of deliberate unfair treatment. The evidence shows the unfair discrimination is in the outcomes (of claims).”

The investigation - known as the Section 59 Investigation Panel - followed allegations by members of the National Health Care Professionals Association that they were being unfairly treated and their claims were withheld by medical schemes because of the colour of their skin and their ethnicity.

Advocate Ngcukaitobi along with advocates Adila Hassim and Kerry Williams probed these allegations over several months which resulted in their interim report.

The issuing of the preliminary report was meanwhile challenged by the Government Employees Medical Scheme (Gems) which rushed to the Gauteng High Court, Pretoria, over the weekend to stop the report from being released and made public.

Gems argued that they should first be given the opportunity to comment on it, before “scathing allegations” against them and other schemes are made public.

The issuing of the interim report has been postponed on two previous occasions, but the panel said it was ready to divulge its preliminary report on Sunday.

Gems, however, rushed to the urgent court two hours before the report was due to be made public. Judge Colleen Collis delivered her judgment on Tuesday in which she struck the matter from the roll due to a lack of urgency.

The judge said Gems had created the urgency, as the report was due to be released on December 16. The panel since then postponed the release date twice but indicated that it would be released on ( this past) Sunday.

The judge questioned by Gems did not in December already turn to the court, but now opted to run to court two hours before the due release time on Sunday to try and block the release.

Gems, one of the biggest medical aid schemes in the country, said in its court application that it was told that the interim report contained findings that black healthcare providers “are unfairly discriminated against on grounds of race.”

They said that they should first be able to see the report and comment on it, as these allegations would seriously impact on their good name and reputation.

Judge Collis, however, did not comment on these submissions in her judgment, as she simply removed the matter from the roll due to the urgency technicality.

The report was meanwhile released less than an hour following her ruling.

It was, among others, found that between 2012 and 2019 Discovery, Medscheme and Gems were more likely to find that black practitioners have committed fraud, waste and abuse of the system than their white counterparts.

The investigation further found that Discovery was 35% more inclined to identify black healthcare providers guilty of abusing the system, while Gems was 80% more likely and Medscheme 330% more likely.

“ This means that there was unfair racial discrimination,” the panel concluded.

The panel said it had no power to find anyone guilty.

“Nor were we appointed to investigate the veracity of each claim of unfair treatment and unfair discrimination. But we would be failing in our duty, if we ignored the degrading, humiliating and distressing impact of racism against the individuals who testified before us.”

The panel concluded that their findings will hopefully provide a

basis for the necessary reconstructive work which must be undertaken by the role-players in the medical schemes industry.

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Pretoria News

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