Johannesburg - Fresh from being nailed for racially discriminating against African and Indian private health practitioners, the country’s three major medical schemes now face a class action lawsuit from their victims.
The independent panel that investigated allegations by black practitioners that medical schemes refused to pay them on the basis of their race released its interim report on Tuesday.
Chaired by advocate Tembeka Ngcukaitobi, the panel found black practitioners faced unfair racial discrimination from the Government Employees Medical Scheme (Gems), Discovery and Medscheme.
The three-person panel was appointed by the Council for Medical Schemes, a statutory body. Advocates Adila Hassim and Kerry Williams completed the panel members.
Last year, black doctors took turns detailing to the panel how schemes accused them of fraud, waste or abuse when they sought their money.
Schemes launched investigations into practitioners once they flagged them, withholding due payments in the process, white private practitioners were barely flagged for fraud, waste or abuse, the black doctors said.
Some probes involved planting of clandestine cameras in consulting rooms, the panel was told. Representatives of schemes bluntly denied racially profiling doctors and dirty tricks in probes.
They told the panel doctors were identified by codes and not names, so there was no way any doctors could be targeted.
The panel found in favour of the black doctors. It said the disproportionate impact of schemes’ investigations on black providers amounted to unfair racial discrimination. “Based on an assessment of the evidence, together with the application of anti-discrimination law, the panel is of the view that the outcome of the fraud, waste or abuse investigations, conducted by Discovery, Gems and Medscheme between 2012 and 2019, amount to unfair racial discrimination against black practitioners,” said the report.
The report said Medscheme was 330% more likely to identify black practitioners as guilty of fraud, waste or abuse. Gems followed with 80% likelihood, while Discovery was 35%.
The CMS launched the Ngcukaitobi-chaired panel after Donald Gumede, chairperson of the National Healthcare Professionals Association (NHPA), told the SABC’s Morning Live news programme about the plight of black practitioners.
Gumede told The Star on Tuesday that the association was working towards filing a class action against schemes.
“It’s going to be easy to make a class action because we represent practitioners across the spectrum. The damage that the schemes have done is irreparable. Many practitioners have closed down. Many went into depression, and many committed suicide because of these illegal actions …” he said.
Gumede said he felt vindicated by findings of the panel. “When I started this journey, I was labelled a mad person, but today I’m happy because the truth has come out.”
He expressed caution about chances of the government getting the schemes on the straight and narrow soon. “We hope that they will take the necessary steps. I’m cautious because the majority of our authorities are caught up in these medical aids’ boards,” he said.
Reacting to the report, Medscheme said it “categorically rejected claims that it performs any form of racial profiling when assessing or auditing health-care claims”.
Dr Lungi Nyathi, Medscheme’s executive director, insisted that all they did was to protect funds from fraud and waste.
Discovery said the panel reached its conclusions without pointing out a single fraud investigation that was tainted with inappropriate methods. But the scheme said it accepted the panel’s recommendations. “We will not shirk our responsibility to contribute to a system that is fully transformed and equitable,” it said.
Parties have until March 5 to comment on the panel’s interim report.
The Star