Board of Healthcare Funders hits back at racism allegations in medical aid schemes report

By Zelda Venter Time of article published Jan 19, 2021

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PRETORIA - The Board of Healthcare Funders said that it would closely review the preliminary report issued by the Council for Medical Schemes’ Section 59 Investigation in which it was found that black medical practitioners were unfairly discriminated against.

BHF said in a statement that they would engage with the panel set up to investigate the claims to establish a way forward and to establish remedial interventions where such interventions are required.

Dr Katlego Mothudi, Managing Director of the BHF, said several efforts are being made in the medical scheme industry to root out fraud, waste and corruption. In efforts to do so, the board member schemes follow various processes to determine trends and anomalies in claims, and use these to determine the outcome of claims.

“We are of the view that our members have and had no agenda to intentionally discriminate any of the medical professionals, as we have a zero-tolerance to any forms of discrimination,” he said.

He added that the BHF recognises the negative impact that the issues raised by the panel can have on the healthcare industry, and recognises the impact of fraud and corruption on the healthcare sector.

The board welcomed the processes undertaken by the council of medical schemes as they are of the view that these processes seek to ensure that stakeholders are aligned in purpose and do not engage in activities that may undermine the democratic processes that seek to support any interventions that prioritise and put the welfare and health of citizens first.

The board further said the application by Gems to try and stop the release of the report was triggered by a gap in procedural processes. “The interdict was an effort to ensure that due process is followed in relation to the investigations.”

The board said it recognises that the panel must fulfil its obligations as outlined in its term of reference.

“The panel did not, however, implement the approved terms of reference nor the subsequent processes that it initially indicated would be followed,” the board said.

Medscheme, one of the service providers fingered in the report, has since rejected the allegations.

Medscheme executive director, Dr Lungi Nyathi, said they were disappointed that they were not afforded an opportunity to review the Interim Report of the Panel before it was published publicly, as had been agreed.

"We shall now review the contents of the Interim Report and make a formal submission in response thereto. The company maintains that its duty will always be towards its beneficiaries to validate and verify healthcare claims, and the company does not take this duty lightly," he said.

"Our fiduciary duty to safeguard funds entrusted to us remains to ensure that members and their dependents continue to receive access to healthcare treatment that is affordable and of the highest quality. This function has become even more critical in current depressing economic times, a function without which private healthcare would be substantially more expensive for everyone," he added.

Since the beginning of this process, the company has completed a few internal and external audits to make sure that its processes are beyond reproach. The company maintains confidence that Medscheme’s forensic processes are fair, transparent and within the law.

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