The investigation, to be called the Section 59 Investigation Panel, follows allegations by members of the National Health Care Professionals Association (NHCPA) that they were being unfairly treated and their claims were withheld by medical schemes because of the colour of their skin and their ethnicity.
“The CMS believes that advocate Ngcukaitobi, a respected legal mind, will help get to the root of the allegations of racial profiling, blacklisting for payments, blocked payments, demands of confidential clinical information, bullying and harassment, coercion, entrapment and the use of hidden cameras,” said chief executive and registrar of the CMS, Dr Sipho Kabane.
“According to section 59 of the Medical Schemes Act, the CMS’s mandate is to protect members of the public and take any appropriate steps it deems necessary.
"Our mandate is to measure the quality and outcomes of relevant healthcare services by medical schemes, and to investigate complaints and settle disputes in relation to the affairs of medical schemes For the next four months advocate Ngcukaitobi and two other advocates, Adila Hassim and Kerry Williams, will help probe the allegations,” said Kabane.
Ngcukaitobi is an advocate of the high court and was recently nominated for senior counsel status by the Johannesburg Bar.
Hassim is an advocate of the high court who practises in various areas of the law with a focus on constitutional law. Williams is an advocate of the high court who has advised extensively on healthcare matters over the past 15 years
The Section 59 Investigating Panel will receive written submission from interested parties this month. Interviews and public hearings will be conducted from July to September, and the panel will deliver its final report by November 1.
People are invited to make written submissions to the Section 59 Investigating Panel by June 30. Written submissions could be sent to investigation's.com.
According to StatsSA, at least 10-15percent of all medical schemes claims are fraudulent, abusive or wasteful in nature, a substantial expense in a R150billion industry. Fraud in the private healthcare system is estimated at R22bn a year.