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Medscheme rejects claims of racial profiling when auditing healthcare claims

The medical aid company has responded to the interim report of the Section 59 investigation panel that was tasked with probing allegations that black, coloured and Indian practitioners were discriminated against and singled out as likely to commit fraud.

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JOHANNESBURG - Medscheme has rejected claims that it applies any form of racial profiling when assessing or auditing healthcare claims.

The medical aid company has responded to the interim report of the Section 59 investigation panel that was tasked with probing allegations that black, coloured and Indian practitioners were discriminated against and singled out as likely to commit fraud.

The panel chaired by Advocate Tembeka Ngcukaitobi released the report after the High Court in Pretoria dismissed an application by government medical scheme, GEMS, to block it.

ALSO READ: Medical aids violating constitutional rights of black practitioners, says report

Ngcukaitobi said that while there was no evidence that medical aid schemes deliberately discriminated against black health professionals, at the end of their audits, more black than white professionals were seen as more likely to commit fraud.

“Discovery were more likely to find black professionals have committed fraud, waste and abuse; GEMS is 80% more likely and Medscheme is 330% more likely.”

But Medscheme said that it was disappointed that it was not afforded an opportunity to review the panel’s interim report before it was published, as had been agreed.

Executive director, Dr Lungi Nyathi, said that Medscheme’s fiduciary duty was to safeguard members’ funds and their access to affordable quality healthcare.

Nyathi said that Medscheme’s forensic processes were fair, transparent and within the law.

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