An inquiry into allegations of racial discrimination by medical aid schemes has found that they had unfairly treated black healthcare providers and practitioners.
Adv Tembeka Ngcukaitobi, chairperson of the section 59 inquiry, said the panel had concluded that the tool used by SA’s medical schemes to detect and punish fraud and waste was procedurally unfair and resulted in racial bias.
The panel handed its report to health minister Aaron Motsoaledi in Centurion on Monday. The inquiry reviewed practices from 2012 to June 2019.
The investigation was launched after public allegations in May 2019 by members of the National Health Care Professionals Association and Solutionist Thinkers.
At the time, they said that medical schemes and their administrators were withholding payments and targeting black medical practitioners unfairly based on their race.
In response, the Council for Medical Schemes established an independent investigation panel to probe the allegations.
During the briefing, Ngcukaitobi said: “[…] in our interim report, we found that there was unfair discrimination on the grounds of race, which was prima facie in breach of the Equality Act and in breach of Section 9 of the constitution.
“We have gone to great lengths to explain the evidence [that] the panel assessed to decide if the fraud, waste, and abuse systems as implemented between 2012 to June 2019 [were discriminatory].
“In relation to the historic period 2012 to 2019, we have found that the schemes have not materially disputed the risk ratios that [were] calculated.”
Ngcukaitobi said the risk ratio is a tool that was developed to work out the likelihood that a black practitioner would be subjected to an investigation, a finding, and a penalty vs the same happening to a white practitioner.