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File picture: Pexels

Medscheme, Discovery and GEMS fingered in report alleging racism by medical schemes

By Staff Reporter Time of article published Jan 19, 2021

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Cape Town - A new report released by the Council for Medical Schemes has some damning information on the racial discrimination present in some South African medical schemes.

The interim report was released on Tuesday, after a court application to try and prevent it from being released failed.

The Board of Healthcare Funders and Government Employees Medical Scheme (GEMS) tried to block the release of the report at the last minute, but Judge Colleen Collison ruled that both parties failed to convince her why they had not approached the court earlier, since the report’s release had originally been planned for December.

The investigation began in 2019, after a number of complaints by black medical practitioners. These practitioners claimed that they were being unfairly targeted.


According to the report, Medical schemes and administrators are 1.4 times more likely to conclude that black health-care practitioners have committed fraud, waste and abuse when compared to their non-black counterparts.

The Section 59 Investigation Panel that looked into these allegations was chaired by Advocate Tembeka Ngcukaitobi.

The panel found no evidence of explicit racial bias in the algorithms and methods schemes and administrators used to identify health-care practitioners who had potentially done wrong.

“However, using the data that Discovery, GEMS and Medscheme provided the panel ... there is a substantial difference in fraud, waste and abuse outcomes between black and non-black practitioners over the period January 2012 to June 2019,” Ngcukaitobi said.

Ngcukaitobi further added that the probability that there was no correlation between racial status and the outcome of fraud, waste and abuse proceedings was “for all practical purposes” zero.

Medscheme, Discovery and GEMS have all contested the statistics by Zaid Kimmie, a statistical expert who was appointed by the panel.

Kimmie argued that he found that there was a definite disproportionate impact of fraud, waste and abuse investigations on black providers, which amounted to unfair discrimination.

The report also claimed that the procedures followed by the medical schemes in probing fraud, waste and abuse cases were unfair.

The panel found that schemes and administrators were “policing” practitioners.

Ngcukaitobi argued that the panel’s role was to provide a safe place for individuals to express their experience of racial discrimination and unfair treatment.

“We had no power to find anyone guilty. Nor were we appointed to investigate the veracity of each individual claim of unfair treatment and unfair discrimination. But we would be failing in our duty if we had ignored the degrading, humiliating and distressing impact of racism against the individuals who testified before us,” he said.


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