Damning allegations of racism by medical schemes released

In the period between 2012 and 2019, black practitioners were more likely to be found to have committed fraud, waste and abuse than their white counterparts.

Photo for illustration: iStock

A much-anticipated Section 59 investigation into racial discrimination from medical schemes has been made public.

The Council for Medical Schemes back in 2019 appointed advocates Tembeka Ngcukaitobi, Adilla Hassim and Kerry Williams to probe allegations of unfair treatment and discrimination.

The report released on Tuesday cited that there was no deliberate unfair treatment nor evidence of that by the schemes but the outcomes of the schemes’ actions showed clear evidence of discrimination.

The report found that some of the current procedures followed by schemes to enforce their rights in terms of Section 59(2) of the Medical Schemes Act were unfair.

It found that black providers were unfairly discriminated against on the grounds of race.

In the period between 2012 and 2019, black practitioners were more likely to be found to have committed fraud, waste and abuse than their white counterparts, by Discovery, Medscheme, and Government Employees Medical Scheme (Gems).

Medscheme was 330% more likely to identify black providers as guilty of fraud, waste and abuse while Discovery was 35% more likely to identify black providers as having committed fraud, waste, and abuse, and Gems was 80% more likely to identify black providers.

Black psychologists are three times more likely to be identified as fraud, waste and abuse cases while black registered counsellors and social workers are also three times more likely to be identified as fraud, waste and abuse cases.

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The initial report said that more than 50% of black registered counsellors have been identified as fraud, waste and abuse cases.

This is the highest rate among the disciplines analysed and black dieticians are two times more likely to be identified as fraud, waste and abuse cases compared to their non-black counterparts.

Although the panel was not appointed to investigate single cases of unfair treatment, it said it was not going to ignore the degrading, humiliating and distressing impact of racism.

Panel leader Ngcukaitobi stressed that the report was still an initial report, and that medical schemes affected had only six weeks to rebut the report. He said the final report may be completed by the submissions after the six weeks has lapsed.

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