Johannesburg -
The CMS review followed allegations made by members of the National Health Care Professionals Association who alleged they had been unfairly treated and their claims withheld by medical aid schemes based on the colour of their skin and ethnicity.Last Thursday, Medscheme attended a meeting convened by CMS.
“A medical scheme has a fiduciary duty to protect the funds of their members and they cannot be required to continue honouring claims when the validity is in question, a medical scheme does not require a court judgment to recover overpaid funds, specifically because the claims have already been paid in good faith,” Pedersen said.
"When we do invite providers for interviews, we encourage them to have legal representation. We do not use hidden spy cameras or fake membership cards to entrap a suspect under investigation.
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