Report finds three medical aid schemes ‘guilty’ of racial discrimination.

An interim report released recently has found three medical aid schemes guilty of racial discrimination towards black medical practitioners. In early 2019, a number of healthcare providers and members of Solutionist Thinkers and the National Health Care Professionals Association made allegations that they were being treated unfairly by medical aid schemes based on race and ethnicity. The Council for Medical Schemes (CMS) then launched an investigation into the allegations and released damning findings this week.

Chairperson of the inquiry, Advocate Tembeka Ngcukaitobi and his panel, held public hearings last year commissioned by the CMS. The panel was mandated to investigate two main issues; whether there is racial discrimination by schemes against black health care providers and whether black providers were being treated procedurally unfairly.

They have now released their report after a court dismissed an application by the GEMS medical scheme to block the release.

After considering all the evidence and responses, they found that between 2012 and 2019 black practitioners were more likely to be found to have committed Fraud, Waste and Abuse (FWA) than their non-black (white) counterparts, by Discovery, Medscheme and GEMS.

“This means, for the reasons provided in this interim Report, there was unfair racial discrimination,” the report stated.

“Using the data that Discovery, GEMS and Medscheme provided the Panel and Dr Kimmie, there is a substantial difference in FWA outcomes between black and non-black practitioners over the period January 2012 to June 2019,” it said.

“Over this period, across all disciplines and the aforementioned three schemes and administrators, black practitioners were 1.4 times more likely to be classified as having committed FWA than those identified as not black,” it added.

Black general practitioners are 1.5 times more likely to be identified as FWA cases than their non-black counterparts. The rate at which black physiotherapists are identified as FWA cases is almost double (1.87) that of their non-black counterparts. Black psychologists are three times more likely to be identified as FWA cases and black registered counsellors and social workers are also three times more likely to be identified as FWA cases.

“More than 50% of black registered counsellors have been identified as FWA cases – this is the highest rate among the disciplines analysed, and black dieticians are 2.5 times more likely to be identified as FWA cases compared to their non-black counterparts,” it added.

The report said there are clear differences in the scale of racial discrimination between the three medical aid schemes.

“Discovery was 35% more likely to identify black providers as having committed FWA. GEMS was 80% more likely to identify black providers and Medscheme was 330% more likely to identify black providers as guilty of FW,” it said.

“We have found that some of the current procedures followed by schemes to enforce their rights in terms of section 59 of the Act are unfair. We have also found that black providers are unfairly discriminated against on the grounds of race,” it added.

Medical aid scheme, Medscheme rejected the claims  shortly after the interim report was released. It rejected claims that it performs any form of racial profiling when assessing or auditing healthcare claims.

The Executive Director at Medscheme, Dr Lungi Nyathi said; “we are extremely disappointed that we 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 statement went on to say that the company maintains confidence Medscheme’s forensic processes are fair, transparent and within the law. The South African reached out to GEMS and Discovery for further comment, however, there was no response at the time of publication.

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