South Africa’s largest medical scheme for public servants, Gems, is facing mounting pressure from unions. They want to limit its 2026 premium increase to single digits. This follows a controversial 13.4% hike this year. Following several years of modest increases, the double-digit rise for 2025 drew strong opposition from public sector unions. These include the Public Servants Association (PSA) and…
Tag: GEMS
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Medical Fraud: A Discussion on Race and Class
The long-awaited final report from the Section 59 inquiry has left more questions than answers regarding medical aid fraud in South Africa. The investigation, initiated by the Council for Medical Schemes (CMS) after complaints of racial bias from healthcare providers, found that while fraud detection methods were fair, black practitioners were disproportionately found guilty of fraud, waste, and abuse (FWA).…
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Racial Bias Report: Are the Claims Valid?
A fuse has been lit in South Africa’s private healthcare industry following the release of a controversial racial bias report. It claims black healthcare providers are disproportionately targeted in fraud investigations. The Section 59 report, submitted to Health Minister Dr Aaron Motsoaledi, alleges systemic racial discrimination by medical schemes. However, leading industry bodies have hit back, labelling the racial bias…
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Gems Denies Racial Profiling in Investigations
The Government Employees Medical Scheme (GEMS) has told Parliament that it does not target black doctors based on their ethnicity during fraud investigations. In response to the allegations, Gems denies engaging in racial profiling against any of its practitioners. The assurance comes in the wake of a damning industry report. This report concluded that its systems were “procedurally unfair” and…
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Discovery Health Challenges ‘Flawed’ Racial Bias Report
Discovery Health has issued a sharp rebuke to the findings of the Section 59 inquiry. It alleged the company’s systems demonstrated racial bias against black healthcare practitioners. The final report, handed to Health Minister Dr Aaron Motsoaledi, asserted that Discovery, along with Medscheme and the Government Employees Medical Scheme (Gems), employed procedurally unfair systems. These systems disproportionately penalised black professionals.…
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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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Public Servant Concerns on Redirecting Medical Aid Contributions
Plans to redirect South African public servants’ significant medical scheme contributions into the proposed National Health Insurance (NHI) fund face considerable hurdles. Delegates at the annual Board of Healthcare Funders (BHF) conference heard this on Tuesday. Any such move would necessitate complex changes to public servants’ conditions of service. Staunch resistance to this process is likely. Public servants currently benefit…
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Final report on racial profiling investigation delayed again
The long-awaited final report from the Section 59 Investigation Panel, appointed by the Council for Medical Schemes (CMS) to probe allegations of racial profiling and discrimination by medical schemes and their administrators, has been delayed once again. The CMS now anticipates the report’s release by the end of the year, following ongoing challenges beyond its control. Initially launched in 2019…