Committee on Health Welcomes Findings of Section 59 Investigation Panel

The Chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, has welcomed the findings of the Section 59 investigation panel, which has uncovered systemic racial discrimination in the implementation of fraud, waste and abuse systems by medical schemes and administrators.

“The report paints a concerning picture of the disproportionate impact that medical schemes' fraud, waste and abuse systems have had on black healthcare providers,” said Dr Dhlomo. “The statistical evidence presented by the panel’s expert, clearly demonstrates that black providers were significantly more likely to be found guilty of fraud, waste and abuse compared to their non-black counterparts.”

The panel’s analysis revealed that across the three major schemes investigated – Discovery, GEMS and Medscheme – black providers were between 1.5 to 3.5 times more likely to be identified as guilty of fraud, waste and abuse. In certain disciplines, such as physiotherapy, psychology and social work, the risk ratios for black providers were even higher, reaching up to 12 times more likely to be found guilty.

“These findings are deeply troubling and point to systemic flaws in the design and implementation of the fraud, waste and abuse systems,” continued Dr Dhlomo. “It is unacceptable that black healthcare providers have been subjected to such blatantly discriminatory treatment, which has undoubtedly had a devastating impact on their livelihoods and the communities they serve,” he said.

The committee commends the panel for its thorough and independent investigation, and welcomes the recommendations made to the Council for Medical Schemes (CMS) to ensure the ongoing monitoring of the fraud, waste and abuse systems to prevent further discriminatory outcomes.

Dr Dhlomo stated that he is in discussions with the Minister of Health, Dr Aaron Motsoaledi, about the report. The aim is to ensure that the Minister, the Department of Health, and the entities that the committee oversees and that have been implicated will be invited to provide a briefing to the committee on the findings, outcomes and recommendations presented in the report.

“We cannot allow such systemic discrimination to continue unchecked, as it undermines the transformation of the healthcare sector and the constitutional right to equality,” said Dr Dhlomo.