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An investigation panel headed by attorney Tembeka Ngcukaitobi has found that some of the largest health care schemes in South Africa are guilty of “unfair racial discrimination” in the results of their investigations of fraud, waste and abuse of black health care providers.
Less than two hours after the Pretoria High Court struck the Government Employees Medical Program (GEMS) attempt to intercept the release of the list panel’s interim report, Ngcukaitobi and his fellow panelists released their main findings, which they make scathing findings against GEMS, Medscheme and discovery.
“After considering all the evidence and responses, we found that between 2012 and 2019, black practitioners were more likely to have committed fraud, waste and abuse than their non-black (white) counterparts, per Discovery, Medscheme, and GEMS.” the panel stated.
“This means that, for the reasons set out in this interim report, there was unfair racial discrimination.”
Ngcukaitobi and advocates Adila Hassim and Kerry Williams were appointed by the Council on Medical Schemes to investigate allegations by members of the National Health Professionals Association (NHCPA) that they were being treated unfairly by medical schemes and their claims being held in based on your race. and ethnicity.
The panel found no “evidence of explicit racial bias in the algorithms” used to identify potential fraud, waste, and abuse by healthcare professionals (but found that only Discovery had provided these algorithms), or in the methods that administrators and the schemes used to identify such practices.
However, using the data that Discovery, GEMS and Medscheme had provided to the panel and its statistical analyst, the panel found that “there is a substantial difference in the results of fraud, waste and abuse between black and non-black professionals during the period of January 2012 to June 2019 “.
“During this period, across all disciplines and the three aforementioned schemes and administrators, black practitioners were 1.4 times more likely to be classified as perpetrators of fraud, waste and abuse than those identified as non-black.”
Discovery, GEMS and Medscheme told Fin24 that they would issue statements or comment later. This story will be updated to reflect the statements and other comments if they are released.
According to the panel’s conclusions:
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