A research group led by lawyer Tembeka Ngcukaitobi has found that some of South Africa’s leading medical aid programs are guilty of “unfair racial discrimination” in the results of their investigations into fraud, waste and supplier abuse. black sanitary ware.
Less than two hours after the Pretoria High Court attacked the Government Employees Medical Scheme (GEMS) attempt to ban the publication of the group’s interim report, Ngcukaitobi and colleagues presented their main findings , which draw scathing conclusions against GEMS, Medscheme, and Discovery.
“After considering all the evidence and answers, we find that between 2012 and 2019 it was found that black practitioners had committed fraud, waste and abuse than their non-white (white) counterparts, by Discovery, Medscheme and GEMS.” stated the panel.
“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 Medical Schemes Council to investigate allegations of members of the National Association of Health Care Professionals (NHCPA) who were being unfairly treated for medical schemes and their claims were withheld based on their race and ethnicity.
The group found no “explicit racial bias evidence in the algorithms” used to identify possible fraud, waste and abuse by health professionals (but recorded that only Discovery had provided these algorithms), nor in the methods that the administrators and systems use to identify these practices.
However, using data that Discovery, GEMS and Medscheme had provided to the group and its statistical analyst, the group found that “there is a substantial difference in the results of fraud, waste and abuse among black professionals. and not black during the period from January 2012 to June 2019 “.
“During this period, among all the disciplines and the three schemes and administrators mentioned, black practitioners were 1.4 times more likely to be classified as committing 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 statements and other comments if posted.
According to the group’s conclusions:
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