Latest news with #NationalHealthCareProfessionalsAssociation
eNCA
7 days ago
- Health
- eNCA
Discovery Health denies discrimination following Section59 report
JOHANNESBURG - Discovery Health has questioned the Section 59 inquiry released on Monday. In its reaction, the medical aid scheme's CEO, Dr Ron Whelan, denied any form of discrimination and that the findings were flawed in methodology. "Discovery has no way of identifying race of members or providers. We work exclusively on a numbering system," Whelan says. Section 59 inquiry found that medical aid schemes have acted unfairly and in a racially discriminatory manner towards black healthcare providers. This inquiry stems from complaints dating back to 2019. Members of the National Health Care Professionals Association (NHCPA) and Solutionist Thinkers, made public allegations that they were being discriminated against by medical schemes. Additionally, they alleged that their claims were being withheld based on their race and ethnicity. The affected parties appealed to the Minister of Health for intervention. Whelan, however, insists that processes are compliant and ethical. Meanwhile, health professionals who complained that they were being treated unfairly have been vindicated. Among those who welcomed the report was the Solutionist Thinkers Group which represented over 200 doctors in this probe. The group's chairperson, Nomaefese Gatsheni, says they are thrilled by the results but ashamed of those who have rejected the report.
IOL News
08-07-2025
- Health
- IOL News
Medical schemes racially targeted black healthcare providers
Health Minister Aaron Motsoaledi received the final report from the Section 59 Investigation Panel on Monday. Image: Siyabulela Duda| GCIS A PANEL established to probe allegations of racial discrimination by medical schemes has detailed how black healthcare providers were unfairly targeted by having their claims withheld based on race and ethnicity. Health Minister Aaron Motsoaledi received the final report from the Section 59 Investigation Panel on Monday. The inquiry stems from public allegations made in May 2019 by members of the National Health Care Professionals Association (NHCPA) and Solutionist Thinkers, who alleged that medical schemes and administrators were unfairly withholding their claims based on race and ethnicity. An independent investigation panel, known as the Section 59 Inquiry and comprising Advocate Tembeka Ngcukaitobi SC (Chairperson), Advocate Adila Hassim, and Advocate Kerry Williams, probed the allegations, to identify trends and make recommendations that may require legal or policy interventions. The main focus of the investigation was on fraud, waste and abuse (FWA) and FWA systems, which refers to the systems used by the medical aid schemes and administrators to detect, investigate and determine providers who engage in FWA. This investigation sought to determine if there is a systemic flaw in the Schemes and Administrators FWA systems, particularly the part of the system which claws back monies for providers where the schemes have suffered loss. According to the report, the written submissions alleged that the schemes were intimidated and bullied providers through the implementation of their FWA systems, including by refusing to reimburse providers directly. The schemes were alleged to be treating providers unfairly and in particular were alleged to be targeting black providers. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Next Stay Close ✕ 'The Schemes' FWA systems all made use of software or algorithms that were designed to flag providers who were suspected of engaging in FWA. The FWA systems also all made use of other investigative techniques – staff within the Schemes would receive the details regarding providers who were flagged as engaging in suspicious FWA behaviour and thereafter would engage with these providers, often requesting additional information from the providers to test if they were correctly flagged. None of the Schemes relied entirely on their software or algorithms to determine if a provider was guilty of FWA.' A statistical analysis on the data found that across the board (regardless of the Scheme or Administrator involved; and generally in relation to almost all of the health care disciplines), black providers were much more likely than non-black providers to have been found guilty of FWA by the Schemes and Administrators concerned. This greater likelihood was measured in what has become known as a 'risk ratio'. 'The FWA system produces disparate outcomes based on race – demonstrates that there are probably errors in the FWA systems which must be corrected. For GEMS, black dental therapists in 2014 experienced risk ratios of between 2.7 and 3.27 – i.e. were generally approximately three times (300% more) more likely than non-black dental therapists to be guilty of FWA. For Discovery, black psychiatrists in 2017 experienced risk ratios of between 3.44 to 3.77 – i.e. black psychiatrists were generally approximately three and a half times (350% more) more likely than non-black psychiatrists to be guilty of FWA. For Medscheme, black anaesthetists in 2018 experienced risk ratios of between 6.39 and 6.78 – i.e. black anaesthetists were generally approximately six and a half times (650% more) more likely than non-black anaesthetists to be guilty of FWA. 'Much of the evidence placed before the Panel suggested that there may be systemic unfair discrimination in the implementation of the FWA systems by the Schemes. Systemic discrimination is an issue which has not been extensively addressed by our courts or administrative bodies.' The Panel recommended that there be full algorithmic transparency. 'We explained that the full workings of the algorithm should be visible, transparent and accessible to both the people who use algorithms but also to the people who are affected by the algorithmic systems. Specifically, it is necessary that the inputs into, and construction of, the algorithm should be known.'
The South African
07-07-2025
- Health
- The South African
Damning report confirms racial bias by SA medical aid schemes
A damning report by the Section 59 Investigation Panel has confirmed longstanding allegations of racial discrimination by South African medical aid schemes against black healthcare providers. The findings were handed over to Health Minister Dr Aaron Motsoaledi on Monday by panel chair Advocate Tembeka Ngcukaitobi. The independent inquiry was established following complaints lodged in 2019 by the National Health Care Professionals Association and Solutionist Thinkers, who alleged that claims by black practitioners were disproportionately withheld or scrutinised based on race and ethnicity. Ngcukaitobi confirmed that the panel found compelling evidence of systemic racial bias. 'Evidence of the risk ratios before us showed racial discrimination against black service providers by the schemes,' he said. 'Black is a generic term that includes Coloureds, Indians, and Africans.' Using a statistical tool called a risk ratio, the panel measured the likelihood of black practitioners being subjected to investigations and penalties compared to their Wwhite counterparts. At GEMS (Government Employees Medical Scheme) in 2014, Black dental therapists were 2.7 to 3.7 times more likely to be found guilty of fraud, waste, and abuse (FWA). (Government Employees Medical Scheme) in 2014, were to be found guilty of fraud, waste, and abuse (FWA). At Discovery Health in 2017, Black psychiatrists were 3.44 to 3.77 times more likely to be penalised than non-Black psychiatrists. These ratios translate to a 300-370% higher likelihood of black professionals being implicated in FWA cases. Beyond the racial disparity, the investigation also found that the procedures used by schemes in FWA inquiries lacked fairness and transparency. 'The FWA procedures for the recovery of monies allegedly owed are unfair, and they violate the rights to procedural fairness of individual practitioners,' said Ngcukaitobi. An interim report was previously submitted in 2021, but the final findings now confirm what many in the medical community have long argued – that black healthcare providers face disproportionate scrutiny under the current medical aid system. The release of the report is expected to prompt renewed calls for reform within the medical aid sector. Stakeholders are now awaiting the Health Minister's response and potential recommendations for systemic changes. The findings raise serious questions about equity, transparency, and accountability within South Africa's private healthcare administration. Let us know by leaving a comment below, or send a WhatsApp to 060 011 021 1 Subscribe to The South African website's newsletters and follow us on WhatsApp, Facebook, X and Bluesky for the latest news.
The Citizen
03-05-2025
- Health
- The Citizen
Mpumalanga doctor wins second award for motiviational book
An award-winning author, medical practitioner, co-founder of the National Health Care Professionals Association and the founder of Ezempilo/Dza Mutakalo talk show recently won her second award for her book, Fortitude. Dr Prudence Buthelezi, well known as Dr Pru, was awarded as the best author during the Emerge Africa Awards, held in Midrand on April 5. Buthelezi's story is one of inspiration and determination. As an award-winning author she advocates for people living with disabilities and has made a significant impact with her book. Growing up with a sister living with brain injuries, and later becoming a mother to a son with epilepsy and ADHD, Buthelezi learned the importance of mental health, strength and resilience. These perspectives shaped the women she has become and inspired her writing. ALSO READ: Pienaar author releases her second book to encourage men She quoted one of her favourite Bible verses. 'What I have learned is that, through Christ, I can do all things and nothing is impossible with Him,' Buthelezi said. Her faith and determination have driven her to be a highly successful author and medical practitioner. Fortitude encourages caregivers of people living with disabilities and their families to adopt the principles in the book as a way of thinking. It speaks of mental strength as an ability everyone can develop by seeing the silver lining in stressful circumstances. ALSO READ: Ermelo teen uses her traumatic past to inspire others 'Being a medical doctor played a role, and contributed when I was writing this book. I doubt I would have written it if I was not a doctor,' she also mentioned that her book also moves to eradicate the stigma and the mystery that plagues children living with albinism, cerebral palsy and Down's syndrome. As Buthelezi looks to her future, she remains committed to her passion for writing and helping people. She added that she is still cooking her new upcoming book. At Caxton, we employ humans to generate daily fresh news, not AI intervention. Happy reading!
