Panel finds unfair discrimination against black practitioners by medical schemes
Between 2012 and 2019, black practitioners were more likely to be found to have committed fraud, waste and abuse (FWA) than their white counterparts by Discovery, Medscheme and the Government Employees Medical Scheme (Gems).
This is the finding of a panel appointed by the Council for Medical Schemes to investigate allegations by a number of health-care professionals that they were being treated unfairly by medical aid schemes based on race and ethnicity.
The panel said after considering all the evidence and responses, it found that there was unfair racial discrimination against some black practitioners by three medical schemes.
However, it said it did not find evidence of explicit racial bias in the algorithms and methods that the administrators and schemes used to identify fraud, waste and abuse.
The panel, led by advocate Tembeka Ngcukaitobi, was appointed during the course of 2019 to investigate allegations made by members of the Solutionist Thinkers and the National Health Care Professionals Association.
The panel said there were clear differences in the scale of racial discrimination between Discovery, Gems and Medscheme.
The panel found that Discovery was 35% more likely to identify black providers as having committed fraud, waste and abuse, Gems was 80% more likely to identify black providers as guilty of the same, while Medscheme was 330% more likely to identify black providers as guilty of fraud, waste and abuse.
“Although each of the three schemes and administrations presented expert evidence to contest the findings, we find that the disproportionate impact on black providers, which amounts to unfair racial discrimination, remains,” Ngcukaitobi said at the presentation of the interim report.
He said with regard to Medscheme, assuming the correctness of their expert’s methodology, it was 35% more likely to find black providers guilty of fraud, waste and abuse.
According to Gems' own version, it was 47% more likely to find black providers guilty, and in the case of Discovery it was 36% more likely to find black providers guilty of fraud, wastage and abuse.
“Based on an assessment of the evidence, together with the application of anti-discrimination law, the panel is of the view that the outcome of the FWA investigations, conducted by Discovery, Gems and Medscheme between 2012 and 2019, amount to unfair racial discrimination against black practitioners,” Ngcukaitobi said.
The panel said it has no power to find anyone guilty. “Nor were we appointed to investigate the veracity of each individual claim of unfair treatment and unfair discrimination. But we would be failing in our duty if we ignored the degrading, humiliating and distressing impact of racism against the individuals who testified before us.”
Ngcukaitobi said at this stage, though these findings had been described as strong, they were nevertheless interim.
He said these findings might change, depending on what comments the panel will receive in the next six weeks.
He said the six-week comment period will enable each and every scheme to present further rebuttal of the report.
“We hope the final report will be enriched by submissions which will be made in the next six weeks,” Ngcukaitobi said.