Medical schemes face scrutiny over racial discrimination

THERE must be consequences and punitive measures, which include back payments by medical schemes, that were found to have applied systemic discrimination against black health professionals when they applied risk ratios against them.

- CHEVON BOOYSEN

This call has come after the findings of a Section 59 investigation report revealed that three medical schemes, namely GEMS, Medscheme, and Discovery, applied discriminatory risk ratios to black health professionals, in disciplines such as physiotherapy, psychology, and social work, who are ‘more likely’ to be guilty of fraud, waste, and abuse.

It is unclear how many medical professionals were affected by racial profiling and how many lost their business practices.

The investigation was launched in 2019 after several healthcare providers made allegations they were being unfairly treated by medical aid schemes based on race and ethnicity. The affected section relates to the payment of claims by black medical professionals.

However, in the absence of remuneration guidelines by the National Health Act, Health Minister Aaron Motsoaledi, during a portfolio committee meeting on Friday, said they will seek legal advice on the matter.