BLACK HEALTHCARE PROVIDERS RACIALLY TARGETED

We won't leave any stone unturned against errant medical schemes, says Motsoaledi

- NICOLA DANIELS

A PANEL established to probe allegations of racial discrimination by medical schemes has detailed how black healthcare providers were unfairly targeted by having their claims withheld based on race and ethnicity.

Health Minister Aaron Motsoaledi received the final report from the Section 59 Investigation Panel yesterday.

The inquiry stems from public allegations made in May 2019 by members of the National Health Care Professionals Association (NHCPA) and Solutionist Thinkers, who alleged that medical schemes and administrators were unfairly withholding their claims based on race and ethnicity.

An independent investigation panel, known as the Section 59 Inquiry and comprising Advocate Tembeka Ngcukaitobi SC (Chairperson), Advocate Adila Hassim, and Advocate Kerry Williams, probed the allegations, to identify trends and make recommendations that may require legal or policy interventions.

The main focus of the investigation was on fraud, waste and abuse (FWA) and FWA systems. This refers to the systems used by the medical aid schemes and administrators to detect, investigate and determine providers who engage in FWA.

This investigation sought to determine if there is a systemic flaw in the Schemes and Administrators FWA systems, particularly the part of the system which claws back monies for providers where the schemes have suffered loss.