Black doctors cry foul over medical scheme payment processes

The SA Human Rights Commission (SAHRC) on Wednesday began hearing testimony on claims that some black medical practitioners suspect medical schemes are using coercion, unlawful investigations and other means to hold them ransom before they are paid out.

"When your money is withheld you cannot pay your bond, you can't pay your cars, you can't pay your workers, you can't buy medication, so what you have is the majority of people close down," National Health Care Professionals Association (NHCPA) chair Dr Donald Gumede said.

The association earlier lodged a complaint with the SAHRC. The commission on Wednesday held a preliminary hearing in Braamfontein, Johannesburg, to investigate if it should launch a full inquiry into medical aid schemes.

Gumede claimed that medical schemes hold some healthcare practitioners ransom by paying patients directly or withholding payments from practitioners unless they pay a sum up front, before the medical schemes pay out the rest.

The NHCPA believes these alleged practices might be racially motivated, as they have not received similar complaints from white health practitioners.

"[The medical schemes'] aim is to destroy the black and Indian or coloured healthcare practitioners... But I believe that God will help us as doctors," the NHCPA's Dr Thandi Mkhize said.

Gumede claims medical aids unlawfully hire private and forensic investigators to target some healthcare practitioners and often demand confidential doctor-patient information to prove suspected fraud. "They are a law unto themselves," he said.

Discovery Health CEO Jonathan Broomberg described the NHCPA's submissions as "wild and unproven" allegations.

"They provided no evidence for those. In our view, all of their submissions are opinion …. We do not intend to refute or respond to any of those allegations," Broomberg said. "There is no evidence for that [racial discrimination] at all."

Medscheme CEO Anthony Pedersen hit back at the NHCPA's allegations about medical schemes illegally obtaining healthcare practitioner or patient information.

"When they become members of a medical scheme, they provide a lot of their information and as part of that they also provide the medical scheme with written consent in order to manage the payment of the treatment."

The Government Employees Medical Scheme (Gems) principal officer, Dr Gunvant Goolab, said they did not record the racial profiles of the healthcare practitioners on their database.

The association's claims will also be investigated by a Council for Medical Schemes (CMS) panel led by advocate Tembeka Ngcukaitobi. Its public hearings are to be conducted from July to September, with a final report expected on November 1.