A group representing black and Indian medical providers say they are being used as scapegoats for wastage in the private medical sector.
- A group representing black and Indian medical providers say they are being used as scapegoats for wastage in the private medical sector.
- It also blames the regulator, the Council for Medical Schemes, for this.
- It claims the regulator is not adequately investigating waste and abuse of the system by medical schemes and their administrators.
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The body representing black and Indian medical practitioners says they are used as scapegoats to prop up medical schemes’ reserves.
The this comes after the Council for Medical Schemes commissioned a Section 59 investigation into alleged discrimination against non-white medical service providers by medical schemes. In 2021, the independent panel that undertook the investigation found evidence showing that Discovery, Medscheme and the Government Employees Medical Scheme (GEMS) were more likely to find black service providers guilty of fraud, waste and abuse.
The Solutionist Thinkers Group, which represents 260 black and Indian healthcare practitioners, said in its legal submissions to the virtual hearings on the Section 59 investigation that it “strongly believes there is intentional racial profiling” in the industry.
And in a twist of events, the Solutionist Thinkers Group is further pointing fingers at the CMS, too, saying that the regulator has played a big part in perpetuating an unjust narrative that undermines trust and confidence in black participants in the private healthcare system.
The chairperson of the Solutionist Thinking Group, Nomaefese Gatsheni, told the independent panel on Tuesday that the CMS had ignored its requests to meet and decide the way forward since the publication of the 2021 interim report.
She said it had been “business as usual”, and criticised the relationship between the CMS and schemes. Gatsheni believes rather than seeing an improvement, some of the fingered medical aids are becoming “worse” in terms of requesting “unfair audits” on black practitioners.
“The Solutionist Thinking Group strongly believe there is intentional racial profiling of black healthcare providers by the schemes such as Discovery, Medscheme, and GEMS. The purpose behind this profiling was to hinder the growth and expansion of black healthcare practices,” she said.
Gatsheni takes issue with the fact that the CMS did not meet with the Solutionist Thinking Group after the 2021 report, but then allegedly held a seminar about fraud, waste and abuse in the medical schemes industry, inviting the accused schemes. She alleged that the focus of that summit was to point fingers at black medical providers for committing fraud and claimed the regular had not adequately probed fraud, waste and abuse of the system by the medical schemes and their administrators.
Gantsheni said:
We refuse to be used as scapegoats for mismanagement of schemes’ funds by the schemes and their administrators. We are aware that money extorted from us is used to secure schemes’ reserves.
Gatsheni went on to allege that due to clawbacks of funds that schemes claim doctors gained fraudulently, or by abusing the system when they offered expensive treatment instead of economically proven alternatives, have led to some of its members taking their lives.
She said some schemes have pulled back on those clawbacks and “unfair audits” since the 2021 interim report, but said Medscheme had “moved from better to worse”.
“Healthcare practitioners continue to face demands for information dating back beyond 90 days, requiring audits spanning up to two or three years,” said Gatsheni.
In a statement sent to News24 after Gatsheni’s presentation, Medscheme said all its investigations are initiated based on a prediction for irregular billing and have no racial bias in any manner or form.
“We categorically reject all claims suggesting that Mescheme performs any racial profiling when auditing healthcare claims. It is our further assertion that the Medscheme datasets contain no racial information or indicators,” wrote the administrator.
Gatsheni said GEMS has stopped conducting “unfair audits” since that 2021 report. She said Discovery Health is “on and off”. But while she still considers it “brutal”, it no longer audits as many Solutionist Thinkers Group members as it used to.
The CMS had not responded to the Solutionist Thinkers Group’s group allegations that it perpetuates discrimination against black providers at the time of publication.