The SA Private Practitioners Forum says it has no evidence medical schemes are using racial profiling to determine which of its members to investigate for fraud but the medical scheme coding system was at the centre of what appeared to be harassment of doctors.
Business Live reports that this was according to its submission to the Council for Medical Schemes (CMS) investigation into allegations from the National Healthcare Practitioners Association (NHCPA) that medical schemes and administrators are targeting black and Indian doctors for fraud investigations and unfairly withholding payments. The medical schemes industry regulator is conducting its second round of public hearings into the matter this week.
The report says the SAPPF, which represents specialists, raised concerns about the methods used by medical schemes to flag potentially crooked doctors among its membership base, but was adamant there was no racial dimension to it. The SAPPF did not keep records of their members’ race, but had “guestimated” the race of members who had been investigated based on their surnames and geographic location, SAPPF president Adri Kok said.
The Independent Community Pharmacy Association (ICPA) told the inquiry that it had conducted a survey among its 1,100 members, and found 82% of those audited by medical scheme administrators were black-owned. This was evidence of racial profiling, said ICPA deputy chair Kgabo Komape, since only 35% of the ICPA’s members were black-owned enterprises. However, the report says, he was unable to tell the panel how many ICPA members had participated in the questionnaire and did not provide details of the survey’s methodology.
The SAPPF said the medical schemes coding system used in the country was at the centre of what appeared to be harassment of health practitioners. According to an Eyewitness News report, Kok said doctors outside cities suffered the most because the schemes didn’t understand the conditions under which they operated.
The report says Kok was one of many practitioners who have been investigated by medical schemes.
Kok said in some cases, funders didn’t know what a specialist physician did and, in her opinion, where doctors don’t comply their association should be the final arbiter. “If the doctor doesn’t comply, there is the HSPCA (Health Professions Council of South Africa) because we cannot afford fraud.”