Am­bu­lance wars end in probe

The Star Early Edition - - NEWS - KHAYA KOKO

NET­CARE 911 will be probed by the Com­pe­ti­tion Com­mis­sion fol­low­ing damn­ing al­le­ga­tions against the gi­ant am­bu­lance ser­vice provider that it is abus­ing smaller pri­vate providers.

The anti-com­pet­i­tive al­le­ga­tions were made by the Pri­vate Am­bu­lance Ser­vices As­so­ci­a­tion (Pasa), which claims that Net­care 911 “is killing their small busi­nesses” through an “un­fair” ar­range­ment that Net­care 911 has with 37 med­i­cal aid schemes.

It claims the ar­range­ment sees Net­care 911 as­sess­ing claims of its com­peti­tors af­fil­i­ated to Pasa, which has a mem­ber­ship of 12 com­pa­nies, and de­cid­ing on whether its com­peti­tors should be paid for ser­vices ren­dered.

The in­ves­ti­ga­tion into Net­care 911, a wholly owned sub­sidiary of listed health group Net­care Limited, will form part of the Com­pe­ti­tion Com­mis­sion’s in­quiry into the health sec­tor launched ear­lier this year to as­cer­tain whether there are un­fair mar­ket prac­tices in pri­vate health­care.

Pasa chair­per­son Malebo Ma­bal­ane said their or­gan­i­sa­tion’s main con­cern was how Net­care 911 was re­ject­ing Pasa’s claims that sup­pos­edly met Net­care’s own guide­lines, as to what con­sti­tutes an emer­gency.

“Net­care tells us that ab­dom­i­nal pains, ma­ter­nity is­sues and dizzi­ness are not emer­gen­cies. Now we sit back and ask our­selves: ‘How can you say ma­ter­nity is not an emer­gency? How can you say ab­dom­i­nal pain or dizzi­ness is not an emer­gency?’

“I can­not tell a pa­tient that he or she is not dy­ing. I can­not leave a pa­tient be­hind, but that is what Net­care 911 wants us to do.”

Sipho Mn­tombeni of the health mar­ket in­quiry ac­knowl­edged that Pasa’s com­plaint would form part of the in­quiry into un­fair prac­tices.

Ac­cord­ing to an email signed by se­nior Net­care 911 man­agers Carl de Mon­tille and David Stan­ton, fac­tors that Net­care 911 con­sid­ers an emer­gency in­clude an emer­gency that re­quires im­me­di­ate sur­gi­cal or med­i­cal treat­ment. If not im­me­di­ately treated, the email added, sev­eral things could hap­pen to a pa­tient, in­clud­ing death or im­pair­ment of a bod­ily func­tion.

How­ever, the chief fi­nan­cial of­fi­cer at Supreme Care EMS, Ino­cen­tia Nya­wose, pro­vided ev­i­dence to The Star of a re­jected “emer­gency” claim, where the pa­tient who re­ceived as­sis­tance from Supreme Care had to mo­ti­vate on be­half of Nya­wose’s com­pany for it to be paid by Net­care 911 for ser­vices ren­dered.

The pa­tient, who is from Katle­hong in Ekurhu­leni, was hos­pi­talised for al­most two weeks with se­vere headaches caused by her clin­i­cal de­pres­sion.

But Net­care 911 re­jected this claim be­cause it was a “non-emer­gency use of an am­bu­lance”, ac­cord­ing to Stan­ton. “I could not drive my­self to hos­pi­tal as I was feel­ing dizzy. I was then trans­ported by Supreme Care to Bot­sh­e­long Hos­pi­tal. I’m cur­rently still ad­mit­ted at Akeso Clinic in Al­ber­ton,” the pa­tient wrote to Net­care in mo­ti­va­tion.

But Net­care 911’s case man­ager Natalie Hart­nady al­legedly re­jected the mo­ti­va­tion and closed the case. The re­jected amount, which Hart­nady said Nya­wose should re­coup from the pa­tient, was roughly R1 200, ac­cord­ing to Supreme Care’s credit con­troller Rosina Al­fandika.

Speak­ing to The Star, Net­care 911’s man­ag­ing direc­tor Craig Grindell said they con­duct thor­ough checks on claims to all providers to en­sure that the cor­rect clin­i­cal care was pro­vided as de­fined in the Med­i­cal Schemes Act. “Claims are only ever down­graded or not paid if

Net­care 911 is killing their small busi­nesses

the ser­vices were not pro­vided or were ren­dered for non-emer­gency con­di­tions… In each case, full and trans­par­ent feed­back is pro­vided to the ex­ter­nal providers.”

Asked whether this ar­range­ment fos­tered anti-com­pet­i­tive­ness and hin­dered new en­trants, Grindell said their scheme clients ap­pointed them be­cause of Net­care 911’s su­pe­rior re­sources, and the ar­range­ment did not con­tain any “ex­clu­siv­ity pro­vi­sions”.

A spokesper­son for the Coun­cil of Med­i­cal Schemes ac­knowl­edged the ex­is­tence of the ar­range­ment and said there was “no sound rea­son why med­i­cal schemes should not con­tract with in­de­pen­dent providers if they are ca­pa­ble of ser­vic­ing their mem­bers in all ge­o­graphic ar­eas where they re­side”.



MUSCLE: The Com­pe­ti­tion Com­mis­sion is prob­ing al­le­ga­tions that Net­care 911 is keep­ing smaller providers out.

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