BL Premium reports that an inquiry by an independent panel has found that under the fraud detection systems used by SA’s biggest medical schemes, black practitioners face a markedly higher risk ratio for audit and sanction than their white counterparts.

Discovery Health, the Government Employees Medical Scheme (GEMS) and Medscheme were cited as primary actors in a pattern described as procedurally unfair and discriminatory. But the Board of Healthcare Funders (BHF) has rejected the report, calling its methodology and interpretations unsound and warning that adoption could undermine industry integrity. “We believe these findings are demonstrably and fundamentally flawed and, if allowed to stand, will open the door for runaway fraud and corruption in the healthcare sector,” the BHF argued. The Council for Medical Schemes (CMS) appointed the panel in 2019 after black healthcare providers alleged racial discrimination by medical schemes, and its final report was handed to health minister Aaron Motsoaledi on Monday. The findings imply risk ratios are more than six times for black anaesthetists contracted by Medscheme, and three times and three and a half times for black dental therapists at Gems and black psychiatrists at Discovery, respectively. Despite rejecting the findings, the BHF acknowledged that some providers had raised valid concerns about fairness and transparency and that member schemes had implemented reforms. According to the BHF, fraudulent claims, overservicing, abuse of benefits and improper billing practices cost SA’s medical schemes about R30bn annually.

• Read the full original of the report in the above regard by Jana Marx at BusinessLive (subscriber access only)
• Read too, Health minister weaponising racial bias report to push NHI, says IRR, at The Citizen

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