The South African Society of Physiotherapy has lost its legal challenge against medical scheme clawbacks. The High Court in Pretoria dismissed the society’s application to have Section 59(3) of the Medical Schemes Act declared unconstitutional and invalid. The judgment ends a five-year legal battle involving the Minister of Health, the Council for Medical Schemes and the country’s medical schemes. The…
Tag: Medical Schemes Act
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Section 59 Investigation: CMS Promises Binding Fraud Code
South Africa’s medical schemes regulator says it will implement the recommendations of the Section 59 Investigation into alleged discrimination against black healthcare providers. The commitment was made during parliamentary scrutiny of stalled reforms linked to both the Section 59 process and the Health Market Inquiry (HMI). The Council for Medical Schemes (CMS) launched the investigation after complaints from black providers…
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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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Compulsory Medical Aid for MPs: ActionSA’s Proposal
In a bold move to ensure public representatives experience the same healthcare realities as the citizens they serve, ActionSA MP Kgosi Letlape has announced plans to introduce the Parliamentary and Provincial Medical Aid Scheme Amendment Bill. This proposed legislation aims to abolish compulsory membership of the Parliamentary Medical Aid Scheme (Parmed) for Members of Parliament (MPs), Members of Provincial Legislatures,…
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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).…