Discovery Health breaking the law with delayed clawback from members, says MediCheck

Medical aid members affected by the Discovery Health pharmacy claims error are up in arms about being required to refund the scheme in various ways, including money being withheld for doctors' visits.

The processing mistake continued over a period of almost a year, from January to December 2025, resulting in some clients' reportedly being overpaid a total amounting to tens of thousands of rand. 

According to Discovery, the error affects only about 0.6 percent of members and impacts those on the Executive, Comprehensive and Priority plans.

RELATED: Discovery Health wants money that was erroneously paid to members

Discovery Health CEO Dr Ron Whelan maintains that the scheme is obligated in terms of the regulations, to recover monies that are erroneously paid.

MediCheck, an organisation that helps medical aid members resolve claims disputes, vehemently disagrees in this case.

Discovery has breached the law in a number of instances here, says MediCheck CEO Mark Hyman.

This includes the regulation contained in the Medical Schemes Act that stipulates a scheme is entitled to claw back money if it is within 30 days of a claim being paid, Hyman says.

So far, MediCheck has received over 800 complaints it is lodging with Discovery.

MediCheckSA says it is currently reviewing the legal position in terms of the Medical Schemes Act 131 of 1998 together with the Main Body of Rules of Discovery Limited.

It advises members who have been 'served' with a claw back letter to email their complaints to dhclawback@medicheck.net.za: "Under no circumstances accept a Payment Plan or sign any Acknowledgment of Debt until MediCheck engages with the Scheme."

For more detail, listen to the conversation with Hyman in the interview audio at the top of the article