Sunday, 24 January 2021


Black medical practitioners have welcomed a high-level report that acknowledges their unfair treatment by top medical aids, and have called for the system – which has made treating patients difficult and forced practices to shut – to be urgently rectified.

Some practitioners – which include doctors, psychologists and optometrists – have shared their harrowing treatment from the medical aid schemes, which blocked payment claims for the services rendered to their patients.

Discovery, Medscheme and the Government Employees Medical Scheme (Gems) were named in the report.

The Council for Medical Schemes' Section 59 Investigation was led by advocate Tembeka Ngcukaitobi, who released his report this week. The investigation looked into allegations of racial profiling and medical unfairness against black medical practitioners.

The report said that African, coloured and Indian healthcare practitioners in private practices had been subjected to racial discrimination between 2012 and 2019.

The panel recommended effective relief, a public and unconditional apology to black health-care workers and that administrators and schemes report to the Council for Medical Schemes within three months their measures to mitigate and remove the unfair discrimination against black providers.

Medical aids are feeling the heat to rectify the serious accusations in the report, but have rejected claims of racial profiling when assessing or auditing health-care claims.

Dr Lungi Nyathi, executive director at Medscheme, said they were disappointed that they had not been afforded an opportunity to review the report prior to it being published.

“The company maintains confidence that Medscheme’s forensic processes are fair, transparent and within the law,” said Nyathi.

Dr Stanley Moloabi, principal officer at Gems, said they would use the afforded six weeks by the investigating panel to study the report and, thereafter provide formal comment.

“Gems has nothing to hide and have throughout the process co-operated with the panel,” said Moloabi.

“Gems has a zero-tolerance to all forms of discrimination and pledges to implement corrective action where such remedial interventions are required and as recommended by the panel for the benefit of our members and health-care providers.”

Discovery’s senior reputation manager, Nthabiseng Chapeshamano, said while the organisation did not accept any racial discrimination in their processes, they accepted and respected the panel’s recommendations and would work hard to ensure that outcomes were more satisfactory, balanced and representative in the future.

The report found that:

Black general practitioners are 1.5 times more likely to be identified as fraud waste and abuse (FWA) cases than their white counterparts.

The rate at which black physiotherapists are identified as FWA cases is almost double (1.87) that of their white counterparts.

Black psychologists are three times more likely to be identified as FWA cases.

Black registered counsellors and social workers are also three times more likely to be identified as FWA cases.

More than 50% of black registered counsellors have been identified in FWA cases – this is the highest rate among the disciplines analysed.

Black dieticians are 2.5 times more likely to be identified as FWA cases compared to their non-black counterparts.

The panel found that some of the current procedures followed by schemes to enforce their rights in terms of the law were unfair. 

“These findings are both serious and far-reaching... The evidence shows the unfair discrimination is in the outcomes (of claims),” the report said. 

The investigation followed allegations by members of the National Health Care Professionals Association that they were being unfairly treated and their claims were withheld by medical schemes because of the colour of their skin and their ethnicity.

"The complaints of racial discrimination must be taken seriously by the schemes and administrators. In order to understand how a normative system creates unfair consequences, it is necessary to consider the position of the people who are telling you it is not working for them. This is because the power relations operate from the position that is established as the norm and so it operates for the comfort and benefit of the powerful norm,” read the report.

Shortly after the release of the report, Ngukaitobi said individual medical practitioners may approach the Council for Medical Schemes to have an individual dispute adjudicated and also to have redress.

“Where most of the work has to happen is with the schemes themselves, what we hope for is not necessarily redress to individual practitioners but structural systematic changes,” he said.

“Most of the work that our panel does is reconstructive work, it is how we create a new society out of the ashes of a racist one. We should stop race denialism, in other words accepting that race remains a crucial element defining our lives.” IOL


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