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Medical aid inquiry told regulatory council couldn’t ensure schemes paid fairly

The Section 59 investigation was probing allegations of racial profiling and withholding of payments to black and Indian doctors by medical aid schemes.

CENTURION - The inquiry into the alleged unfair payment of medical practitioners by medical aid schemes on Tuesday heard that the Council for Medical Aid Schemes - set up to regulate the relationship between those involved - was toothless.

The Section 59 investigation was probing allegations of racial profiling and withholding of payments to black and Indian doctors by medical aid schemes.

Advocate Thembeka Ngcukaitobi and his panel were told that the council had resource constraints and was unable to ensure that schemes paid fairly.

Complaints from medical practitioners included that medical aid schemes unilaterally blacklist them and Ngcukaitobi wanted to know where they get that power.

Dr Sipho Kabane of the Council for Medical Aid Schemes said one of their challenges was human resource constraints that prevented them from having an impact.

The council said, in the past, medical aid claims were abused but the legislation also didn’t provide time frames for the investigation of irregularities and admitted this could also marginalise practitioners.

The council’s John Letsoalo said health professionals were also at the mercy of medical schemes.

“Some of the rules we have sought to have them scrapped but the medical schemes have appealed on those and we have failed to set them aside.”

Letsoalo said the schemes could block practitioners without relying on anything and are non-compliant with their own rules and Medical Schemes Act.

Meanwhile, the council's Thembekile Phaswane also said that while health professionals globally were sworn to secrecy regarding a patient’s information unless the patient consented, in South Africa, doctors were violating this.

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