South African Medical schemes face scrutiny over racial discrimination findings

The Council for Medical Scheme (CMS) is seeking legal opinion on appropriate actions to take following the investigation into systematic discrimination against black healthcare providers by medical schemes.

This was announced by Health Minister Aaron Motsoaledi, while responding to parliamentary questions posed by ActionSA MP Kgosi Letlape, who wanted to know the measures he intended to implement to hold medical schemes accountable for the racial discrimination that was uncovered by the Independent Section 59 Panel.

In his response, Motsoaledi said CMS was in the process of procuring a firm of attorneys to develop a comprehensive legal opinion to advise it on appropriate actions to be implemented.

“This opinion will assist CMS in systematically considering the associated risks and determining how to act against those identified in the final report, as well as identifying mechanisms to legally protect individuals who have been negatively affected by the discriminatory practices uncovered,” he said.

Presented by panel chair Advocate Tembeka Ngcukaitobi, the report found systemic procedural unfairness and a deeply entrenched power imbalance that over the years has disproportionately and negatively impacted black medical professionals.

The inquiry, launched in 2019, scrutinised practices by medical aid schemes such as Discovery, Medscheme and the Government Employees Medical Scheme (GEMS) between 2012 and 2019.

Motsoaledi said the department has engaged with CMS since the release of the report.

“An engagement platform through a multi-disciplinary stakeholder committee is still to be established in consultation with CMS. In parallel, there is a process of establishing an internal task team to oversee the proposed action or implementation plan in line with the recommendations of the report.”

Motsoaledi also said he was in support of legislative and regulatory amendments to provide stronger oversight and enforcement powers over medical schemes engaging in discriminatory conduct.

Meanwhile, Health Portfolio Committee chairperson Sibongiseni Dhlomo said they received a briefing on a report detailing systematic discrimination against black healthcare providers by medical schemes.

Dhlomo said the committee has made several recommendations in response to the findings of the report.

“One key recommendation was to establish an early warning system within medical schemes to alert healthcare providers to potential issues arising under Section 59 of the Medical Schemes Act. The committee believes such a system would safeguard honest practitioners from unwarranted scrutiny, while enabling timely corrective actions to mitigate financial losses.”

He added that the committee has resolved to consult with legal advisors about possible legislative amendments to improve transparency and accountability.

“It also stressed the need for a comprehensive strategy to address the backlog of complaints with the Council for Medical Schemes.”

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