Medscheme to review report on racial discrimination against black practitioners

Medscheme on Tuesday rejected claims it practised any form of racial profiling when assisting or auditing health-care claims.

The largest medical health risk management services provider was responding to the release of an interim report by a panel convened by the Council for Medical Schemes to investigate allegations made by a number of health-care professionals that they were being treated unfairly by medical aid schemes based on race and ethnicity.

The report, released on Tuesday, found that 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 the Government Employees Medical Scheme (Gems).

The panel said after considering all the evidence and responses, it found there was unfair racial discrimination against some black practitioners by the three medical schemes.

However, the panel said it did not find evidence of explicit racial bias in the algorithms and methods the administrators and schemes used to identify fraud, waste and abuse.

Dr Lungi Nyathi, executive director at Medscheme, said the medical aid scheme was extremely disappointed it had not been afforded an opportunity to review the interim report before it was published publicly.

“We will review the contents of the interim report and make a formal submission in response,” she said.

She said Medscheme's duty will always be towards its beneficiaries to validate and verify health-care claims.

“Our fiduciary duty to safeguard funds entrusted to us remains to ensure members and their dependents continue to receive access to health-care treatment that is affordable and of the highest quality.

“This function has become even more critical in current depressing economic times, a function without which private health care would be substantially more expensive for everyone.”

Nyathi said since the start of the investigation, Medscheme had completed internal and external audits to make sure its processes were beyond reproach.

TimesLIVE