Board of Healthcare Funders to work with panel probing discrimination
The Board of Healthcare Funders (BHF) says its members have no agenda to intentionally discriminate against any medical professional.
The board said it has a zero-tolerance for any form of discrimination.
It was responding to the release on Tuesday of an interim report by a panel convened by the Council for Medical Schemes (CMS) to investigate allegations made by a number of healthcare professionals that they were being treated unfairly by medical aid schemes based on race and ethnicity.
The report 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).
Medscheme on Tuesday indicated it will review the panel’s interim findings.
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.
The board’s members include medical schemes and administrator and managed care organisations throughout southern African.
The board said efforts were being made in the medical scheme industry to root out fraud, waste and corruption.
Board MD Dr Katlego Mothudi said the private healthcare industry was battling a high prevalence of fraud and corruption.
He said fraud and corruption was worsened by a lack of visible policing, gaps in monitoring systems, inappropriate consequence management processes, long-standing malpractices that have become entrenched as well as low levels of information sharing within the industry.
He said in efforts to address fraud and corruption, BHF member schemes followed different processes to determine trends and anomalies in claims and use these to determine the outcomes of claims.
“We are of the view that our members have and had no agenda to intentionally discriminate against any of the medical professionals as we have zero-tolerance for any forms of discrimination,” he said.
Mothudi said the BHF, together with impacted members, will closely review the full report and engage with the panel and the CMS to find a way forward and establish remedial interventions where required.