Racism report released COVID CARE
BLACK DOCS FLAGGED: ‘PROBABILITY OF THIS OCCURRING BY CHANCE IS ZERO’
Up to 330% more likely to be tagged for fraud, waste and abuse, panel finds.
Anewly released interim report on allegations that some of the country’s biggest medical aid schemes have been racially profiling doctors suggests that in some instances, black practitioners are up to 330% more likely to be flagged for fraud, waste and abuse (FWA) than their white counterparts.
In 2019, the Council for Medical Schemes appointed a panel headed by advocate Tembeka Ngcukaitobi to probe allegations that black practitioners were being treated unfairly.
The probe covered the period January 2012 to June 2019 and focused on three schemes in particular: Discovery, the Government Employees Medical Scheme (Gems) and Medscheme.
The investigation found there was, indeed, “unfair racial discrimination”, read the report.
“Over this period, across all disciplines and the aforementioned three schemes and administrators, black practitioners were 1.4 times more likely to be classified as having committed FWA than those identified as not black,” the report said.
The panel described the probability of this having occurred by chance as “for all practical purposes, zero”.
There were, however, “clear differences in the scale of racial discrimination” between the schemes, with experts finding Discovery was 35% more likely to identify black providers as having committed FWA, Gems 80% more likely and Medscheme a staggering 330% more likely to flag them.
The schemes contested these figures. But the panel found, even on their own figures, there was “a disproportionate impact on black providers”.
“With regard to Medscheme, assuming the correctness of their expert’s methodology, it is 35% more likely to find black providers guilty of FWA. On Gems’ own version, it is 47% more likely to find black providers guilty of FWA. [And] on Discovery’s version, it is 36% more likely to find black providers guilty,” it said,
The panel found some of the processes the schemes had adopted to “claw back” on disputed amounts owed to practitioners were unfair.
“These findings are both serious and far reaching. But we believe that it is important to stress that we have not found evidence of deliberate unfair treatment – the evidence shows the unfair discrimination is in the outcomes,” the report said.
The report was made public yesterday, after the High Court in Pretoria threw out an urgent bid from Gems and the Board of Healthcare Funders to interdict its release.
On Sunday, hours before the report was due to be made public, Gems and the board rushed to court, where they argued the report contained “scathing” findings and allegations and that Gems, in particular, had not been given an opportunity to respond.
But Judge Colleen Collis found the case was not urgent, questioning why they had waited until the last minute to approach the court, and struck it from the roll.
Gems was adamant it had never intended to “block” the release of the report, “but to request that due processes be followed in ensuring that affected parties had a view of the report before it was released to the public”.
Gems’ principal officer, Dr Stanley Moloabi, said he had “noted [the findings] with concern”.
“The panel has afforded impacted schemes a period of six weeks to study the report and thereafter provide formal comments based on the interim findings,” he said, “Gems will take this opportunity to closely study the full report findings and the recommendations of the panel to establish a way forward.”
He said the scheme had a “zero-tolerance” stance on all forms of discrimination and pledged to implement corrective action.
Discovery had not had sufficient time and access to analyse the report and would comment further in the coming weeks.
Medscheme “categorically rejected claims that it performs any form of racial profiling when assessing or auditing healthcare claims [and] are extremely disappointed that we were not afforded an opportunity to review the interim report before it was published”, its executive director, Dr Lungi Nyathi, said.
It would review the report and then respond formally.