The Council for Medical Schemes has denied abusing its power to place schemes under curatorship or wasting money on unnecessary litigation, and instead, has accused its detractor – the Board of Healthcare Funders (BHF) – of paying media outlets to attack it.
In a 30-page response to a leaked legal letter sent by the BHF on 16 February to CMS chair Thandi Mabeba and Health Minister Joe Phaahla, the CMS also denied that it failed to comply with the Medical Schemes Act’s requirements of regularly reviewing the prescribed minimum benefits.
It said concerns raised by BHF members are “continuously weaponised through paid media to attack the integrity of the CMS, including its personnel”, reports Business Day.
The CMS report, which was released on Friday, was triggered by a series of media articles published after the letter was leaked in early March. It is alleged in the letter that CMS registrar Sipho Kabane deliberately delayed the introduction of low-cost benefit options, destabilised weak schemes and used curatorship to intimidate the boards of trustees of medical schemes.
At the time, the CMS declined to comment in detail, saying its legal team needed to consider the letter.
It has now published a lengthy response, defending its use of curatorships, the establishment of an inquiry into alleged racial profiling by medical schemes and administrators, and its approach to regulatory reform. It criticises the BHF for taking its concerns to the public, saying the CMS and the courts provided ample mechanisms for resolving disputes.
The CMS had not responded by the time of publication to Business Day’s request to elaborate on its allegation that the BHF had paid media outlets.
The BHF, which represents medical schemes and administrators covering 4.5m beneficiaries in SA, or half the local medical scheme market, rejected CMS claims that it had paid media to publish material attacking the regulator, saying it was an ethical organisation.
The CMS’ report contained many false allegations, BHF MD Katlego Mothudi said. “The ‘paid-for’ media assertion is such an example, as we have never paid any media to run with these stories.”
The BHF said its aim was to advocate for the interests of “health citizens”, and it sought to highlight issues threatening the sustainability of the industry or which had a potentially negative impact on the sector.
The CMS accused the BHF of acting in the interests of industry players – medical schemes and administrators – rather than medical scheme beneficiaries, and said it was “therefore not surprised that the BHF would place the narrow commercial and vested interests of its members above those of the 9.04m medical scheme beneficiaries”.
It also defended its use of curatorship, saying it was ultimately up to the courts to decide whether to grant an application to place a scheme under curatorship, and this was done only when a credible and justifiable case had been made.
Of the 11 schemes placed under curatorship between 2012 and 2023, seven were granted on an ex parte basis, according to figures in the CMS report. An ex parte application allows the regulator to ask the court for a curatorship order without the scheme in question being given an immediate opportunity to oppose it.
While proponents of this approach argue it prevents scheme officials from destroying evidence before a scheme is placed under curatorship, critics say it deprives schemes of an opportunity to oppose being placed under curatorship.
Business Day PressReader article – Medical schemes regulator hits back (Open access)
See more from MedicalBrief archives:
CMS seeks to place Netcare scheme under curatorship
CMS loses appeal over low-cost cover challenge
Court slaps CMS with deadline to explain low-cost schemes hold-up