GEMS outlines plans to address discrimination against black healthcare providers

THE Government Employees Medical Scheme (GEMS) maintains that, since the release of the Interim Section 59 Panel Investigations Report three years ago, it has taken significant steps to strengthen its Fraud, Waste, and Abuse (FWA) management framework in an effort to "eliminate any potential for disparate outcomes.

- NICOLA DANIELS

This follows damning findings against the country's largest medical schemes, which were found to have applied discriminatory risk ratios to Black health professionals. These providers were disproportionately flagged, audited, or penalised through opaque fraud, waste, and abuse (FWA) systems.

The investigation, commissioned in 2019, examined allegations of racial discrimination and procedural unfairness in the application of FWA processes by major schemes and administrators, including Discovery Health, Medscheme and Gems.

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