Health Minister Aaron Motsoaledi said 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.

Motsoaledi was 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..

Letlape also asked whether the department has engaged or consulted with the CMS to ensure that sanctions were imposed on medical schemes found to have engaged in discriminatory practices.

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 in response to the findings of the Section 59 investigation.

“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.

Motsoaledi also said the CMS intended to collaborate with relevant stakeholders and issue appropriate guidance to support the alignment of regulatory frameworks between providers and funders, particularly within the context of the Fraud, Waste, and Abuse Tribunal.

He stated that the department has engaged with CMS since the release of the Section 59 final report.

“However, 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.

He said some of the legislative and regulatory measures currently being explored included a collaborative structure between the CMS and the Health Professions Council of South Africa, and CMS being required to issue more regular guidance on the issues arising from the investigation and sanctioning processes.

“CMS should provide procedural certainty for medical schemes in exercising their powers in terms of the Medical Schemes Act (MSA), the remedies available to parties who feel aggrieved by the conduct of schemes, and the penalties against schemes in the event of a breach of the MSA.”

Meanwhile, Health Portfolio Committee Chairperson Sibongiseni Dhlomo told the media earlier this week that they received a briefing on a report detailing systematic discrimination against black healthcare providers by medical schemes.

He said the committee members expressed concern over the disproportionate allegations of fraud, waste, and abuse directed towards Black practitioners compared to their non-black counterparts.

“Committee members emphasised the need for accountability and sought further information on the punitive measures against medical schemes found guilty of discriminatory practices. They enquired about the department’s intentions to acknowledge the harm inflicted upon black healthcare providers,” he said.

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.”

mayibongwe.maqhina@inl.co.za

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