'Council for Medical Schemes allowing bully-boy tactics'

Allegations that medical aid schemes are racially profiling doctors were denied this week during a Section 59 inquiry.

The Council for Medical Schemes initiated the investigation after complaints by health care practitioners that include claims of intimidation, fraud and attempts to break doctor-patient confidentiality.

RELATED: [LISTEN] Medical aid schemes to be probed for racial profiling, intimidation

ALSO RELATED: SAHRC looking into claims of racial profiling by medical aid schemes

On Weekend Breakfast, Refiloe Mpakanyane asks Proactive Health Solutions CEO, Dr Fundile Nyathi what exactly is being investigated.

He explains that the complaints were prompted by the reported circulation of a racially skewed blacklist of doctors.

The majority of those were actually black and black in the broader sense, that is African, Indian, coloured... There were very few white doctors.

Dr Fundile Nyathi, CEO - Proactive Health Solutions

They felt it needed to be highlighted because some of the colleagues who have been blacklisted, they have gotten into serious financial difficulties and some of them have committed suicide as a result. They felt it cannot continue.

Dr Fundile Nyathi, CEO - Proactive Health Solutions

Dr Nyathi says the Council for Medical Schemes, established by an act of Parliament, is failing in its duty to oversee the industry as it is allowing the schemes to take unilateral action which translates into them assuming the role of prosecutor and judge in one.

That body is supposed to issue regulations about how things must happen.

Dr Fundile Nyathi, CEO - Proactive Health Solutions

If, for example, there is suspicion that a practitioner is involved in illegal or fraudulent activity or even unprofessional conduct, if it is of a criminal nature then that medical scheme, via the Council of Medical Schemes, should then pass that on to the police and NPA (National Prosecuting Authority).

Dr Fundile Nyathi, CEO - Proactive Health Solutions

Dr Nyathi says that is the crux of the problem - at the moment certain medical aids are withholding payment to healthcare practitioners who have already provided services to their patients and, in some cases, banning those professionals from practising at all.

That happens without the law being followed in terms of proper investigation by the right authorities where the practitioner has been found guilty of something.

Dr Fundile Nyathi, CEO - Proactive Health Solutions

That is actually illegal and that is the essence of the complaint.

Dr Fundile Nyathi, CEO - Proactive Health Solutions

This state of affairs also impacts patients.

You may not be able to go and access your family physician, who's got your records, the history of your illness...

Dr Fundile Nyathi, CEO - Proactive Health Solutions

For more detail on this serious issue, listen below:


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