‘Broader investigation overdue’ – ActionSA lodges criminal complaint against medical aids

ActionSA MP and member of the Health Portfolio Committee Dr Kgosi Letlape has lodged a criminal complaints against medical aid schemes.

This follows a report, commissioned by Minister of Health Aaron Motsoaledi, that found racial discrimination against black service providers by the schemes

Chairperson of the independent investigative panel, Tembeka Ngcukaitobi, presented the report’s key findings to the minister on Monday, 7 July.

Findings

The panel was tasked with determining if there were any racial undertones in the medical aid schemes’ treatment of practitioners.

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“The risk ratio is a tool we developed to work out the likelihood that a black practitioner would be subjected to an investigation, a finding and a penalty, versus a white practitioner,” explained Ngcukaitobi.

“What we did have the power to do was make findings of fact, and that finding of fact simply leads to one conclusion: the evidence of risk ratios showed racial discrimination against black service providers by the schemes.”

Ngcukaitobi noted how, in 2017, one private medical aid scheme found black psychiatrists guilty of fraud, waste and abuse (FWA) at more than three times the rate of their white counterparts.

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Another private scheme was shown to have found black anaesthetists guilty of FWA over six times more often than other groups in 2018.

In the government employee medical scheme, black dental therapists were generally three times more likely than non-black dental therapists to be found guilty of FWA in 2014.

‘Critical step’ against medical aid schemes

On Monday, ActionSA said that laying formal criminal complaints was a crucial step to enable investigators to lawfully access the relevant records, communications and case files.

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“These materials are essential to uncovering the full extent of any wrongdoing and ensuring that those implicated are held to account, including both medical schemes and practitioners who may have engaged in criminal conduct,” said ActionSA.

“ActionSA is of the considered view that a broader investigation into the conduct of these schemes is both necessary and overdue.”

The party said a criminal investigation would go a long way in exposing the “deep-seated rot” within the health sector, “ensuring that criminal conduct is rooted out and that discriminatory practices which undermine the very principles of South Africa’s constitutional democracy are brought to an end”.

Additional reporting by Jarryd Westerdale

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