Thursday, 28 March, 2024
HomeSouth AfricaDiscovery rejects 'flawed' race bias findings

Discovery rejects 'flawed' race bias findings

Discovery Health has hit back at expert testimony before the Council for Medical Schemes (CMS) which claimed widespread race bias "in the outcome" of fraud investigations, saying the methodology was severely flawed, Beeld reports. Statistician Dr Zaid Kimmie found black healthcare providers were 42% more likely to be found to have perpetrated offences than their non-black counterparts.

The report says Kimmie’s analysis found no racial grounds in the identification of cases to be investigated, but testified that the “racial bias” in the outcome of the investigations could not be accidental. Discovery Health says it is “absolutely certain” that there is no racial basis. The administrator’s Jonathan Broomberg says Kimmie used subjective criteria by identifying the healthcare providers’ race through their surnames as no scheme holds data about the race of its members and providers.

“Apart from the inherent mistakes due to different interpretations of surnames, the analysis only classified practices with clear African or Indian surnames as black, which means coloured practitioners were classified as white.” Furthermore, Kimmie’s analysis presumed that all companies – a business form often used by optometrists and pharmacies – are white and that is “clearly wrong”.

According to the report, investigation chair Advocate Tembeka Ngcukaitobi SC, said administrators will be able to state their cases next year. He dismissed a request from Discovery on 12 November to comment on Kimmie’s analysis immediately.

Kimmie unpacks his findings in a Netwerk24 interview. He says he was asked to answer two questions: Whether medical schemes have racial bias in identifying suspicious claims and whether the outcome of the investigations point to racial bias. The first question was answered in the negative.

According to him, the panel wants to establish whether the “colour-blind” systems of the schemes still leads to unfair outcomes. Kimmie says he made no findings about the possible explanations for the skewed outcomes.

“The onus is now on medical schemes to provide reasons why they reach these outcomes. My analysis shows that with Discovery, practitioners are 35% more likely to be found guilty of fraud, waste and abuse if they are black. At GEMS, it is 80% and with Medcheme it is 300%.”

[link url="https://www.netwerk24.com/Sake/Muntslim/Mediese-Fondse/discovery-foute-in-ontleding-oor-diskriminasie-20191120"]Beeld report (subscription needed)[/link]

[link url="https://www.netwerk24.com/Sake/Muntslim/Mediese-Fondse/daar-is-vooroordeel-teen-swart-dokters-verslag-20191120"]Netwerk24 report (subscription needed)[/link]

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