HFA happy there is no evidence of explicit racial bias by medical schemes

The Health Funders Association (HFA) has welcomed an interim report which investigated claims of unfair discrimination by medical schemes and administrators against black health practitioners.

The panel appointed by the Council for Medical Schemes (CMS) has found 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).

The panel found there was unfair racial discrimination against some black practitioners by 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 FWA.

The association, which is a representative organisation for medical schemes, administrators and managed care organisations, said it was supportive of the panel’s findings that there was no evidence of explicit or intentional racial bias.

The association, which represents 53% of medical scheme principal members, said the panel had also expressly recognised FWA was serious and damaging and required mechanisms to combat it.

The HFA said it was concerned the panel found there was indirect discrimination in the outcomes of the FWA processes despite there being no explicit or intentional bias.

“The association will seek clarity from the panel on their reasons for discounting the presence of confounding factors (additional variables in cause-and-effect relationships) which may account for the outcomes."”

The HFA said it welcomed the panel’s intention for further constructive engagement on the findings and recommendations of the report in the interest of a unified industry.

The association said it was the duty of all medical schemes, as recognised by the panel, to make sure proper control systems were in place to ensure member funds were used in the provision of health care for its members and protect member funds from FWA.

It said any funds wasted through fraud, waste or abuse are funds belonging to the members of medical schemes.

“Any fraud, waste or abuse of these funds therefore negatively impacts access to health care in a country where health resources are scarce. The HFA and its members are committed to acting in a lawful, fair, impartial and transparent manner at all times.”

The association said it will provide detailed input to the panel on their findings and recommendations.

TimesLIVE