Unauthorised persons and practitioners: Challenges with medical service provision
An “unauthorised person” is someone without the proper permissions, rights, or legal authority to access specific places, information, systems, or perform certain actions. This lack of authorisation could stem from insufficient credentials, permissions, or consent. Unauthorised access or actions are considered violations of rules, policies, or laws. Non-authorised individuals lacking necessary credentials may attempt to provide medical services, contrary to the standards set by licensing authorities.
Background
The term “authorized medical service provider” refers to healthcare facilities or professionals officially recognised or approved by relevant authorities to provide medical services. Authorisation typically comes from government health agencies, regulatory bodies, or entities overseeing healthcare practices. These providers are licensed, accredited, or certified to ensure adherence to certain quality and safety standards.
Education of medical service providers
Medical service providers require academic qualifications ranging from three to six years, accompanied by clinical practice, internship, and, in some cases, residency. Some providers pursue an additional two to five years of postgraduate studies in specialised areas. After qualification, the next step is licensing by authorities. Private practice or affiliation with organisations like Medical Aid, Health Insurance, or Road Accident Funders necessitates individual registration.
Credentialing and licensing of providers
Practising medicine, nursing, and other health-related fields require recognition or equivalency to local standards. Credential verification is crucial. Non-authorised individuals attempting to provide medical services without required credentials pose a significant concern, especially in medical aid, health insurance, and funding sectors.
• Services conducted between countries
When foreign medical practitioners offer services in another country, they’re typically subject to withholding tax on fees rather than income tax. In this scenario, the paying entity is responsible for deducting a percentage from the fees and remitting it to the government, such as the Botswana Unified Revenue Service, where applicable.
• Local billing practices
The practice of “ghost billing,” where a visiting doctor submits billing under a local doctor’s name, is fraudulent and unethical. This deceptive practice can result in overcharging, impacting health insurance premiums, and may even involve tax evasion.
• Billing for non-existent services
“Phantom billing” occurs when a healthcare provider submits invoices for services never rendered or for fictitious patients. This deceitful practice not only constitutes fraud but also undermines the integrity of the healthcare system.
• Multi-location operations
Medical service providers operating in multiple locations must comply with regulatory requirements, uphold professional standards, and fulfill licensing obligations in each jurisdiction where they practice. Adhering to these guidelines ensures the delivery of safe and ethical healthcare services across diverse settings.
• Multiple unregistered providers
Taking action against the presence of unregistered service providers necessitates proactive measures from regulatory authorities. These practitioners may lack the requisite qualifications and oversight to ensure safe and effective patient care. By addressing this issue, we safeguard patient well-being and cultivate trust and confidence in the healthcare institution within the community it serves.
• Regulatory challenges
Regulatory bodies encounter various challenges in overseeing the medical sector, including difficulties in locating registered providers, identifying practitioners per practice, investigating claims involving phantom and ghost billing, ensuring accuracy in coding practices, and enforcing compliance with employment regulations. Addressing these challenges is essential to maintaining the integrity and efficiency of the healthcare regulatory framework.
Conclusion
Challenges within the medical field require a comprehensive understanding of various factors, and it is evident that maintaining integrity and transparency in medical services is paramount. Addressing challenges associated with non-authorised individuals in medical and health practice requires a proactive and adaptive approach by medical and health registration councils. Despite these challenges, it is imperative for all stakeholders, including medical practitioners, regulatory bodies, and healthcare organisations, to collaborate effectively.