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Following the release of the Section 59 Investigation Panel interim report. 14:45
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The National Health Care Professionals Association (NHCPA) says it will launch a class action lawsuit against medical aid schemes following the release of the Section 59 Investigation Panel interim report, which found that there was âsystemic discrimination perpetrated over a number of years,â against black medical practitioners by three healthcare groups.
The Council for Medical Schemes (CMS) launched an investigation in 2019 after members of the NHCPA and Solutionist Thinkers made allegations that their members were being racially profiled, harassed and bullied by medical aid schemes. The two organisations also alleged that medical aid schemes would demand confidential clinical information regarding patients and would withhold payments.
The party called for accountability.
“The EFF calls for stringent action against all the implicated medical schemes. Furthermore, we call for a complete overhaul of the algorithm systems in place to identify fraud and wastage by medical practitioners and all of those leading these medical schemes to face the full might of the law,” said the EFF.
Gems, which was found to be 80% more likely to find black doctors guilty of FWA, attempted to block the release of the damning report. TimesLIVE reports that the scheme approached the court just two hours before it was due to be released on Sunday.
Siyanda Ndlovu The independent panel also found that medical aid schemes and administrators were withholding payments to black and Indian doctors on the perception of fraudulent claims. Picture for illustration: iStock
The report was due to be released on Sunday, only to be blocked by Gems and BHF’s urgent application at the 11th hour.
Ngcukaitobi, advocate Adila Hassim, and Kerry Williams were appointed by the Council for Medical Schemes back in 2019 to probe allegations by the National Health Care Professional Association (NHCPA) of unfair treatment by medical schemes.
Gems filed the application urgently stating that the report was halted because it was going to seriously harm its reputation.
Everything, according to an interim report by a Section 59 investigation panel released on Tuesday.
Two of the country’s largest medical schemes, Discovery and the Government Employees Medical Scheme (GEMS) and Medscheme, one of the largest medical aid scheme administrators in the land were found to have engaged in the unfair racial discrimination against black, Indian and coloured doctors and health practitioners.
The panel’s report, released on Tuesday morning, has damning implications for the three schemes singled out in engaging in unfair racial discrimination and processes when conducting investigations into fraud, waste and abuse cases.
The release of the report came just hours after the Pretoria High Court earlier in the morning threw out the application by the GEMS and the Board of Healthcare Funders to interdict its release.
Panel finds unfair discrimination against black practitioners by medical schemes 19 January 2021 - 12:46 A panel appointed by the Council for Medical Schemes, chaired by advocate Tembeka Ngcukaitobi, has found that black practitioners were more likely to be found to have committed fraud, waste and abuse than their white counterparts by the three biggest medical schemes. File photo. Image: DAILY DISPATCH/LULAMILE FENI
Between 2012 and 2019, black practitioners were more likely to be found to have committed fraud, waste and abuse (FWA) than their white counterparts by Discovery, Medscheme and the Government Employees Medical Scheme (Gems).
This is the finding of a panel appointed by the Council for Medical Schemes to investigate allegations by a number of health-care professionals that they were being treated unfairly by medical aid schemes based on race and ethnicity.