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Dr Prudence Buthelezi, a health practitioner and co-founder of the National Health Care Professionals Association (NHCPA), said this on Thursday as she recounted the experiences she and her colleagues faced over a seven-year period.
The racial profiling were finally given credence by the Section 59 Investigation Panel’s report released this week.
“Today, we say victory is ours. We are the conquerers,” Buthelezi told a virtual and physical audience of fellow practitioners gathered on Thursday, as they reflected on the report findings.
“They [medical schemes] would look at the invoices of black practitioners and where they saw that you saw more than 50 patients [a day], they would highlight you as [being] fraudulent. They would demand [notes on] the time you spent with the patient and would also want the files of those patients,” she went on.
Buthelezi, voice solemn yet resolute, added: “The other thing they did was entrapment – illegal under the law. They would send their spies to our practices [to see if we were indeed getting the patient numbers we claimed].
“The worst thing was when they were withholding our funds – many of us [practitioners] are not with us. We have buried them, they committed suicide because medical aids withheld their funds [and they could no longer pay bills].
“Today others are still seeing patients but aren’t being paid by medical aids. Today we are saying, we have won the victory,” Buthelezi said.
Tuesday’s report was the culmination of a pain-staking two-year process – involving lengthy hearings where black health professionals in their droves shared their experiences of intimidation, trauma and financial distress as a result of medical schemes unfairly targeting them in fraud, waste and abuse cases.
Read: Medical aid schemes have committed unfair racial discrimination – report
Rewind to May 2019
The NHCPA and the Solutionist Thinkers group, made public allegations that they were being racially discriminated against by medical aid schemes and administrators. They said their claims for services rendered were being withheld based on their race and ethnicity.
The Council of Medical Schemes (CMS), the industry regulator, then set up a multi-disciplinary steering committee – consisting of the complainants, industry associations and co-regulators – that supported the establishment of an independent investigation to investigate the allegations.
Chaired by Advocate Thembeka Ngcukaitobi SC, the panel included advocates Kerry Williams and Adila Hassim. It was mandated to investigate two main issues – whether there is racial discrimination by schemes against black health care providers and whether black providers were being treated procedurally unfairly.
“On the first question, after considering all the evidence, we have found that between 2012 and 2019, black practitioners [African, Indian and coloured] were more likely to be found to have committed fraud, waste and abuse than their non-black [white] counterparts by Discovery, Medscheme and the Government Employees Medical Scheme (GEMS),” Ngcukaitobi said on Tuesday.
Ngcukaitobi was reading from an 11-page summary. The full report is more than 300 pages long and details the extensive testimonies from practitioners, medical schemes, administrators and experts.
The panel said that while they had not found explicit racial bias in the algorithms – in other words, an intention to cause discrimination, using the data provided by the schemes – they found “substantial differences” in fraud, waste and abuse outcomes between black and white practitioners during that period.
And that the probability of black practitioners being identified as engaging in fraud, waste and abuse as a mere accident – in many instances, up to twice more likely to be accused and labelled of engaging in fraud, waste and abuse – was zero.
The various medical schemes involved have repeatedly denied being involved in racial discrimination against black practitioners.
In response to the report, the GEMS has undertaken to study the findings and provide formal comments to the panel in the six weeks the interim report is open to comments.
Read: Six things to consider before changing your medical aid cover
Medscheme flatly denied and “categorically rejected” claims of racial profiling. Its executive director Dr Lungi Nyathi said: “We are extremely disappointed that we were not afforded an opportunity to review the interim report of the panel before it was published publicly as had been agreed. We shall now review the contents of the interim report and male a formal submission in response thereto.”
But, for the health practitioners gathered on Thursday the report was a resounding and welcome vindication, after years of their cries of abuse being ignored by the CMS.
Lutendo Phaswana, a physiotherapist and NHCPA member, echoed Buthelezi’s sentiments.
“January 19 unveiled only the tip of the iceberg of the experiences of the black child. It showed that no matter how educated you are as a health professional across the many disciplines, you’ll always be met with undue suspicion if you’re black,” Phaswana said.
“Unfortunately, as we celebrate this major victory, many of our colleagues are suffering from major depression, others committed suicide because they couldn’t bear the humiliation of being labelled fraudsters.”
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