CMS to convene special meeting to discuss findings of medical aid schemes racially discriminating against black service providers
The Council of Medical Schemes was before Parliament’s health committee on Friday to inform parliamentarians how it plans to address the findings of the Section 59 report.
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CAPE TOWN - The Council of Medical Schemes says it will convene a special meeting on Monday to discuss a damning investigation that has found racial bias on the part of three of the country’s biggest medical schemes in determining fraudulent claims.
The council was before Parliament’s health committee on Friday to inform parliamentarians how it plans to address the findings of the Section 59 report.
Meanwhile, Health Minister Aaron Motsoaledi said that amendments may be required to the National Health Insurance Act to respond to the findings of the panel.
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While Discovery Health and Medscheme have rejected the panel investigation as a flawed and unscientific study, the Government Employees Medical Scheme (GEMS) said that no findings of racial intent had been made against it.
The investigation was carried out by a panel of advocates assisted by two experts.
Registrar of the Council for Medical Schemes, Dr Musa Gumede, said that it would take at least four weeks for its own council to be able to deliver a comprehensive response to the report, while an advisory committee grappled with the core issues of fraud, waste and abuse.
"The advisory committee will have to review the document, provide commentary and sign off the report for implementation. It will also be expected to provide input to the council as to how they would like us to take this report forward."
Minister Motsoaledi said that he was not empowered to act against the medical schemes who may be guilty of unfair practices.
"The minister can not just stand up and pick up some penalties in the air, it’s not going to be possible, unless an act of Parliament informs the minister."
The study found that between 2012 and 2019, black medical practitioners were more 1.4 times more likely to be classified as having committed fraud than those not identified as black.