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Interim report: medical aids discriminated against black practitioners

An interim report released has found that Discovery, Medscheme and GEMS have been unfairly classifying black health professionals as likely to commit fraud.

Picture: 123rf.com

JOHANNESBURG - Medical aid schemes have been found guilty of racially discriminating against black medical practitioners.

An interim report released by Advocate Tembeka Ngcukaitobi found that Discovery, Medscheme and GEMS have been unfairly classifying black health professionals as likely to commit fraud.

Chairperson of the inquiry, Ngcukaitobi and his panel, held public hearings last year commissioned by the council for medical schemes.

They have now released their report after the Pretoria High Court dismissed an application by the GEMS medical scheme to block the release.

The Section 59 report probed allegations by members of the National Health Care Professionals' Association who accused medical aid companies of racial profiling, especially when the companies were required to pay doctors.

Some of the professionals said that they were forced to close down and admit to fraud, while others were forced to pay back fees they couldn’t afford.

Ngcukaitobi said that it was unlikely that the discrimination occurred by chance.

“For Discovery, we find that they were 35% more likely to identify black providers as having committed fraud, waste and abuse and this is the lowest rate of the three administrators that we looked at. Discovery has the lowest rate of the likelihood of unfair racial discrimination.”

The inquiry into discrimination by medical aid schemes has found that many health professionals have been forced to close down after being found unfairly of fraud, without a hearing.

Advocate Ngcukaitobi said that Discovery, Medscheme and GEMS had been unfairly classifying black, coloured and Indian health professionals as likely to commit fraud.

Some of the professionals said that they were forced to close down after being coerced to admit fraud and others were forced to pay back fees they could not afford.

"One doctor said: 'My practice is 90% dependent on medical schemes. If they claw back, that will amount to a 90% reduction in my income. I have to close my practice.'"

Ngcukaitobi said that his investigation found that black practitioners were 1.4 times more likely to be classified as likely to commit fraud than their white counterparts.

And he said that there was zero probability that the discrimination occurred by chance.

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