The curator of Sizwe Hosmed responded to critics after they launched legal efforts to liquidate her business and sequester her estate. Lebogang Mpakati, a registered business rescue practitioner, said the proceedings are private matters. She said they have no bearing on her ability to stabilise the troubled medical scheme. Mpakati is facing pressure from the scheme’s suspended board of trustees. The…
Tag: Council for Medical Schemes
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Bonitas Tender Dispute: Court Action and Tender Controversy
South Africa’s second-largest open medical scheme, Bonitas, is opposing an urgent court application by Medscheme to block the appointment of two new service providers. The Bonitas Tender Dispute centres on Bonitas’ decision to end a 44-year administration relationship with Medscheme. Medscheme has served as its administrator since 1982. Bonitas, which covers more than 730,000 people, has appointed Momentum to take…
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Bonitas Medscheme Split Sees Momentum and PHA Win Contracts
The Bonitas Medscheme Split has become a major topic in the South African healthcare sector. Bonitas Medical Fund, South Africa’s second-largest open medical scheme, has confirmed a major supplier shake-up. It will end its long-running administration relationship with Medscheme and hand key roles to Momentum Health and Private Health Administrators (PHA). The changes cover all Bonitas options except Boncap, its…
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Dis-Chem MyHealth Partnership Defends Retail-Led Cover
Dis-Chem has defended its health insurance partnership with Centriq and Kaelo after a ruling by the Council for Medical Schemes (CMS). The pharmacy retailer says the decision clarifies the process. It argues it is not a warning shot against retail-led healthcare models. The CMS found that changes to the branding and presentation of Centriq’s MyHealth insurance products under the Dis-Chem…
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Dis-Chem Insurance Branding Non-Compliant says CMS
A regulatory dispute could ensnare thousands of South African health insurance policyholders following a Council for Medical Schemes (CMS) finding that Dis-Chem’s branding breached the Medical Schemes Act. Davizro | iStock/695273346 The CMS ruled that Centriq Insurance Company’s decision to market its MyHealth Core and MyHealth Vital products under the Dis-Chem name amounted to an unauthorised name change. In the…
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Discovery Health Claims Error Triggers Outrage Over Oversight
A year-long administrative failure at Discovery Health Medical Scheme (DHMS) has sparked mounting frustration among members, as the scheme begins recovering erroneous payments from policyholders. The Discovery Health claims error, which went undetected for 12 months, has affected an estimated 16,000 members across five high-end plans. The administrator, Discovery Health, is now requesting repayment of substantial amounts, some exceeding R68,000.…
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GEMS Tariff Intervention Underway Amid Affordability Concerns
The South African government has stepped into the controversy surrounding sharp increases in contributions to the Government Employees Medical Scheme (GEMS). Public Service and Administration Minister Mzamo Buthelezi told Parliament that officials will engage with GEMS trustees regarding what he called “unaffordable tariffs.” This follows a 9.8% hike in GEMS member contributions this year, on top of a 13.4% increase…
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Bonitas Faces Investigation for Procurement Irregularities
The Council for Medical Schemes (CMS) has officially launched a forensic investigation into Bonitas, the nation’s second-largest open medical scheme. Bonitas faces investigation over allegations of improper procurement processes related to a key contract for its low-income option. The investigation will focus specifically on a contract awarded by Bonitas to Private Health Administrators (PHA) for the administration of its Boncap…
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Medical Schemes Face Legal Action Over Profiling
The Council for Medical Schemes (CMS) is considering legal action against major medical aid schemes and administrators in response to the report. It found evidence of racial profiling against Black healthcare providers. Medical schemes could be heavily impacted. The Council for Medical Schemes (CMS) has warned it may pursue legal action, potentially through the Equality Court, against some of South…
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BHF rejects fraud inquiry’s findings as ‘fundamentally flawed’
South Africa’s healthcare sector is facing a crisis of trust. This follows an independent inquiry finding that the nation’s largest medical schemes have been targeting black healthcare practitioners. They have been targeted in investigations into fraud and abuse. The report sets the stage for a major confrontation over racial equity and regulatory oversight. Moreover, it challenges methods used to combat…
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Inquiry Finds Medical Schemes Guilty of Racial Discrimination
Focus Keywords: Medical Scheme Discrimination, Section 59 Inquiry, Black Healthcare Providers, Discovery, GEMS, Medscheme, Racial Bias, Healthcare Fraud A damning report has concluded that South Africa’s largest medical schemes and administrators, including Discovery, the Government Employees Medical Scheme (GEMS), and Medscheme, have acted unfairly. Their actions represent racial discrimination towards Black healthcare providers. The long-awaited Section 59 inquiry’s final report,…
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Medihelp denies funding for child with Hunter Syndrome
A landmark case before the Council for Medical Schemes (CMS) has highlighted a critical conflict. This is between a medical scheme’s financial health and its obligation to fund life-saving treatment. It has left a young boy’s future in jeopardy. The appeals committee decided that the Medihelp Medical Scheme does not have to fund a vital drug for a six-year-old boy.…