Latest news with #Ngcukaitobi
The Citizen
14-07-2025
- Health
- The Citizen
‘Broader investigation overdue' – ActionSA lodges criminal complaint against medical aids
The party said a criminal investigation would go a long way in exposing the 'deep-seated rot' within the health sector ActionSA MP and member of the Health Portfolio Committee Dr Kgosi Letlape has lodged a criminal complaints against medical aid schemes. This follows a report, commissioned by Minister of Health Aaron Motsoaledi, that found racial discrimination against black service providers by the schemes Chairperson of the independent investigative panel, Tembeka Ngcukaitobi, presented the report's key findings to the minister on Monday, 7 July. Findings The panel was tasked with determining if there were any racial undertones in the medical aid schemes' treatment of practitioners. ALSO READ: Medical aids slammed for procedural unfairness in new report 'The risk ratio is a tool we developed to work out the likelihood that a black practitioner would be subjected to an investigation, a finding and a penalty, versus a white practitioner,' explained Ngcukaitobi. 'What we did have the power to do was make findings of fact, and that finding of fact simply leads to one conclusion: the evidence of risk ratios showed racial discrimination against black service providers by the schemes.' Ngcukaitobi noted how, in 2017, one private medical aid scheme found black psychiatrists guilty of fraud, waste and abuse (FWA) at more than three times the rate of their white counterparts. ALSO READ: More than half of Discovery's medical aid plans saw declines in members last year Another private scheme was shown to have found black anaesthetists guilty of FWA over six times more often than other groups in 2018. In the government employee medical scheme, black dental therapists were generally three times more likely than non-black dental therapists to be found guilty of FWA in 2014. 'Critical step' against medical aid schemes On Monday, ActionSA said that laying formal criminal complaints was a crucial step to enable investigators to lawfully access the relevant records, communications and case files. ALSO READ: Trio of medical aids fail to maintain required liquidity 'These materials are essential to uncovering the full extent of any wrongdoing and ensuring that those implicated are held to account, including both medical schemes and practitioners who may have engaged in criminal conduct,' said ActionSA. 'ActionSA is of the considered view that a broader investigation into the conduct of these schemes is both necessary and overdue.' The party said a criminal investigation would go a long way in exposing the 'deep-seated rot' within the health sector, 'ensuring that criminal conduct is rooted out and that discriminatory practices which undermine the very principles of South Africa's constitutional democracy are brought to an end'. Additional reporting by Jarryd Westerdale READ NEXT: Medical schemes risk ruining their reputations through greed
The Citizen
08-07-2025
- Health
- The Citizen
Health minister weaponising racial bias report to push NHI, says IRR
Health minister Aaron Motsoaledi welcomed a report showing that medical aid schemes were racially discriminating against practitioners. The Institute of Race Relations (IRR) has accused Health Minister Aaron Motsoaledi of using a report into the racial bias of medical aid compliance standards to further his National Health Insurance (NHI) agenda. The report, compiled by a panel chaired by Advocate Tembeka Ngcukaitobi, concluded that medical aid schemes were unfairly discriminating against black practitioners when investigating fraud, waste, and abuse (FWA) claims. To reach this conclusion, the independent panel relied on an equation devised by a mathematician with a PhD from the University of Cape Town. 'The risk ratio is a tool we developed to work out the likelihood that a black practitioner would be subjected to an investigation, a finding and a penalty, versus a white practitioner,' explained Ngcukaitobi. 'What we found is that the FWA procedures, for the recovery of moneys allegedly owed, is unfair and violate the right to procedural fairness of individual practitioners,' said Ngcukaitobi. Minister 'weaponising' the report The report has divided the industry, with some welcoming it and others challenging the methodologies and findings. Motsoaledi was quick to support the report, but Hermann Pretorious, head of Strategic Communications at the IRR, questioned the minister's motives for doing so. 'His opposition to 'two different systems' of healthcare in South Africa is a naked attempt to justify a single system – the NHI,' he told The Citizen. He argued that any implication that the government could implement superior oversight of medical schemes was 'absurd'. He predicted the NHI would 'decimate' freedom of consumer choice. 'The obvious weaponisation of this report and its findings is a blatant and cynical ploy by Minister Motsoaledi to pay little more than lip service to the disgraceful failures of public healthcare under his watch whilst vilifying the most operational and successful part of healthcare in the country,' concluded Pretorious. ALSO READ: Medical aids slammed for procedural unfairness in new report Part of SA's make-up Pretorious found little fault with the report's methodology, suggesting the implied biases were a by-product of South Africa's racially charged society. 'Given the intensely and coercively racialised nature of South African law and regulatory frameworks within which corporates operate, the practice of racial classification and its various offshoots become visible in practices of various complex entities – in both the public and private sector.' Pretorius cautioned against assuming corporate compliance standards were infallible, noting how complex licensing had led to the closure of independent pharmacies and how regulators have frustrated attempts to create low-cost pharmaceuticals. 'Neither over-nor under-regulation helps the South African consumer and economy. What is needed is sensible regulation – particularly in the healthcare industry,' said Pretorius. Report 'flawed' The Board of Healthcare Funders (BHF) rejected the report, highlighting that FBW cost medical aid schemes roughly R30 billion each year, losses that were passed on to consumers. Managing Director Dr Katlego Mothudi said the report was 'demonstrably and fundamentally flawed' and would aid fraud if the recommendations were implemented. Mothudi stated the BHF would not allow the report to distort their work, as they had a 'moral imperative' to end exploitation by practitioners, regardless of race. 'The investigation relied on unscientific methods to assign race, using surnames to categorise providers, despite well-documented inaccuracies and lack of scientific validity in this approach,' he stated. Mothudi explained that patient volumes and exposure bias were not properly considered, nor was the fact that some providers serve a disproportionately large share of scheme members. 'One of the large schemes investigated, which is a member of the BHF, serves a member base that is 91% black, which logically results in a higher rate of member interactions with black providers,' stated the MD. ALSO READ: Motsoaledi announces 1 650 new healthcare jobs and R1.3bn to be spent on hospital equipment The South African Medical Association (SAMA) explained that they were an active participant in the panel's work and called for 'legislative, regulatory, and operational' reforms. SAMA wish to see the Council for Medical Schemes (CMS) publish fixed timelines for the report's implementation within the next 60 days and for the health department to amend the Medical Schemes Act. 'The report validates what many of our members have endured for years: racially skewed targeting, opaque algorithms, and Kafkaesque audit processes,' stated SAMA chair Dr Mvuyisi Mzukwa. He concurred with Ngcukaitobi's assertion that algorithms used by medical aids to detect fraud were flawed and that a transparent, independent system should be implemented. 'Our members have a right to fair treatment, regardless of their race, and patients deserve a health system built on equity and accountability,' said Mzukwa. No racial profiling, says Discovery Discovery Health was adamant that incidents of potential FWA had legitimate grounds for investigation and that there was no evidence of racial profiling. The medical scheme giant cited a 2021 version of the same report, which found their systems to be legally sound, and stated that it was considering the possibility of a formal review of the final report. 'We are deeply concerned that the panel's conclusions are based on flawed methodology, unscientific assumptions, and misinterpretation of complex data,' stated Discovery CEO Dr Ron Whelan. 'We maintain a zero-tolerance stance on any form of racial discrimination and rigorously investigate any such allegations,' Whelan added. Like the BHP, he warned the report would undermine the fraud prevention efforts of medical aids, risk schemes' sustainability and jeopardise member contributions. NOW READ: Medical aids slammed for procedural unfairness in new report
Daily Maverick
07-07-2025
- Health
- Daily Maverick
Probe finds evidence of racial discrimination against black healthcare providers by medical schemes
The section 59 panel investigating allegations of racial discrimination against black healthcare providers by medical schemes in South Africa issued its final report on Monday, 7 July. The section 59 panel's final report, handed to Minister of Health Aaron Motsoaledi on Monday, found that between 2012 and 2019 there was evidence that the fraud, waste and abuse (FWA) systems used by medical schemes showed racial discrimination against black service providers. The investigative panel, commissioned by the Council for Medical Schemes (CMS) and chaired by advocate Tembeka Ngcukaitobi, began looking into the matter in 2019 after healthcare providers, represented by two associations, made public allegations about their treatment by medical schemes and administrators. 'We were not a court of law… We did not have to make legal findings applying the Promotion of Equality and Prevention of Unfair Discrimination Act or applying section 9 of the Constitution, but what we did have the power to do was to make findings of fact, and that… simply leads to one conclusion. The evidence of the risk ratios before us showed racial discrimination against black service providers by the [medical] schemes,' said Ngcukaitobi at a press briefing marking the handover of the report on Monday. According to the CMS, the inquiry focused on two issues: whether there was racial discrimination by medical schemes against black healthcare providers; and procedural fairness in the treatment of black healthcare service providers. Racial discrimination The panel developed a tool to measure the performance of medical schemes' fraud, waste and abuse systems, looking at discriminatory outcomes or unequal treatment for healthcare providers. 'This risk ratio is basically a tool that we developed to work out the likelihood that a black practitioner would be subjected to an investigation, a finding and a penalty, versus a white practitioner,' said Ngcukaitobi, adding that the panel looked at risk ratios across different medical disciplines and years, between 2012 and 2019. The findings included: In 2014, black dental therapists under the GEMS medical scheme were about three times more likely to be investigated and found guilty of fraud, waste and abuse than white dental therapists; In 2017, black psychiatrists under Discovery were about 3.5 times more likely to be investigated and found guilty of fraud, waste and abuse than white psychiatrists; and In 2018, black anaesthetists under Medscheme were about 6.5 times more likely to be investigated and found guilty of fraud, waste and abuse than white anaesthetists. Ngcukaitobi said there was scope to improve the methodology used by the panel to determine the probable risk ratios for different years and disciplines. 'We have explained that the tool… should be continuously improved, but it is useful as a starting point. We have also recommended an annual assessment of the impact of FWA [systems] on black providers… [and] recommended the splitting of specific disciplines in order to monitor the instances of FWA among the healthcare providers,' he said. Procedural fairness The panel released an interim report in 2021, with findings of unfair discrimination on the basis of race. Subsequent to its release, various stakeholders – including medical schemes – had the opportunity to make further submissions to the panel in 2021 and 2023, according to Dr Thandi Mabeba, chairperson of the CMS. '[In the interim report], what we had found in relation to procedural fairness was that the FWA procedures for the recovery of monies allegedly owed is unfair and it violates the rights to procedural fairness of individual practitioners. We found that the schemes should make changes to the manner in which they claw back monies that they claim practitioners owe to them,' said Ngcukaitobi. 'We've received further submissions, but we remain unpersuaded that our interim findings were incorrect. Accordingly, we confirm the findings and recommendations in the interim report that the procedure that is followed by medical schemes, when they claw back money allegedly owed by practitioners or where they investigate instances of fraud, waste and abuse, are unfair.' Ngcukaitobi noted that part of the problem was that the Medical Schemes Act didn't contain procedures for the administration of fraud, waste and abuse systems, leaving it up to individual medical schemes to make decisions about how to investigate possible infractions and impose penalties. 'The legislation is lacking. It has several gaps. It's not keeping up with technology… We say that the CMS, as the regulator responsible for the implementation of the fraud, waste and abuse systems, is required to ensure that schemes and administrators act procedurally fairly. It is within the CMS's discretion as to how it chooses to progress this object with various stakeholders,' he said. Among the recommendations made by the panel to improve procedural fairness in medical schemes' fraud, waste and abuse systems were: Developing an early warning system that allowed medical schemes to notify service providers as soon as schemes became aware of any circumstances which might lead to the application of section 59, subsection 3 of the Medical Schemes Act; Reviewing the 'audit and clawback time period' for medical aid schemes, as there were instances where healthcare providers were called upon to pay back money to schemes years after alleged infractions; Ensuring a mechanism to assist healthcare providers with representation when accused of fraudulent, wasteful or abusive conduct by medical schemes, to prevent isolation or coercion of accused persons; and Providing complete transparency regarding the software, algorithms and artificial intelligence programmes used by medical schemes to monitor claims made by providers and members alike. 'Most of the evidence we had was that there is a software programme that the schemes use to detect fraud, waste and abuse, but there's no transparency in relation to the input into that software programme… and because it's an invisible programme, it's impossible to work out whether it's discriminatory or not in relation to its outcomes,' said Ngcukaitobi. 'If the schemes persist with the argument that they will not allow this transparency because it will undermine the detection of fraud, waste and abuse, then we say the Council for Medical Schemes must introduce a mechanism where… the council itself has full transparency relating to the software, algorithms and artificial intelligence programmes that the schemes use. The schemes ought to be accountable to a public body for the systems they use, as this in turn ensures accountability to the public, whilst maintaining a form of confidentiality.' Upon receiving the section 59 investigation panel's report, Motsoaledi said that the National Department of Health would study the findings before issuing an official statement. BHF rejects findings The Board of Healthcare Funders (BHF), a nonprofit company representing medical schemes and administrators, released a statement rejecting the panel's findings on Monday. 'We still need to study the final report. However, we are disappointed that the section 59 inquiry panel has confirmed that it has upheld the findings made in the interim report released in 2021. We believe these findings are demonstrably and fundamentally flawed and, if allowed to stand, will open the door for runaway fraud and corruption in the healthcare sector,' it said. The board said fraudulent claims, overservicing, abuse of benefits and improper billing practices cost South Africa's medical schemes about R30-billion each year. 'Based on comments made by the section 59 inquiry panel in today's media briefing, the BHF believes that the final report continues to be underpinned by serious methodological and interpretive flaws, all of which we raised following the release of the interim report in 2021,' it said. The issues the BHF raised with the panel's methodology included: Unscientific methods to assign race, using surnames to categorise providers; Failing to account for exposure bias, which occurs when a group is more likely to be involved in a process or activity simply because of greater contact or interaction; and Confusing correlation with causation, by assuming discrimination without 'rigorously considering other relevant variables such as provider billing patterns, patient load, or socioeconomic contexts'. 'Taken together, these cumulative weaknesses undermine the central finding that black providers were nearly twice as likely to be investigated,' it said. According to the BHF, both the board and its members had undertaken 'significant reforms to strengthen fairness, transparency and accountability', including a comprehensive review of fraud, waste and abuse protocols. 'The BHF remains committed to working collaboratively with the CMS, regulators and the healthcare community to strengthen South Africa's healthcare funding system. While we reject the findings of the section 59 investigation as flawed, we remain steadfast in our pursuit of a healthcare system grounded in integrity, justice and sustainability,' said Dr Katlego Mothudi, managing director of the BHF. DM
The South African
07-07-2025
- Health
- The South African
Damning report confirms racial bias by SA medical aid schemes
A damning report by the Section 59 Investigation Panel has confirmed longstanding allegations of racial discrimination by South African medical aid schemes against black healthcare providers. The findings were handed over to Health Minister Dr Aaron Motsoaledi on Monday by panel chair Advocate Tembeka Ngcukaitobi. The independent inquiry was established following complaints lodged in 2019 by the National Health Care Professionals Association and Solutionist Thinkers, who alleged that claims by black practitioners were disproportionately withheld or scrutinised based on race and ethnicity. Ngcukaitobi confirmed that the panel found compelling evidence of systemic racial bias. 'Evidence of the risk ratios before us showed racial discrimination against black service providers by the schemes,' he said. 'Black is a generic term that includes Coloureds, Indians, and Africans.' Using a statistical tool called a risk ratio, the panel measured the likelihood of black practitioners being subjected to investigations and penalties compared to their Wwhite counterparts. At GEMS (Government Employees Medical Scheme) in 2014, Black dental therapists were 2.7 to 3.7 times more likely to be found guilty of fraud, waste, and abuse (FWA). (Government Employees Medical Scheme) in 2014, were to be found guilty of fraud, waste, and abuse (FWA). At Discovery Health in 2017, Black psychiatrists were 3.44 to 3.77 times more likely to be penalised than non-Black psychiatrists. These ratios translate to a 300-370% higher likelihood of black professionals being implicated in FWA cases. Beyond the racial disparity, the investigation also found that the procedures used by schemes in FWA inquiries lacked fairness and transparency. 'The FWA procedures for the recovery of monies allegedly owed are unfair, and they violate the rights to procedural fairness of individual practitioners,' said Ngcukaitobi. An interim report was previously submitted in 2021, but the final findings now confirm what many in the medical community have long argued – that black healthcare providers face disproportionate scrutiny under the current medical aid system. The release of the report is expected to prompt renewed calls for reform within the medical aid sector. Stakeholders are now awaiting the Health Minister's response and potential recommendations for systemic changes. The findings raise serious questions about equity, transparency, and accountability within South Africa's private healthcare administration. Let us know by leaving a comment below, or send a WhatsApp to 060 011 021 1 Subscribe to The South African website's newsletters and follow us on WhatsApp, Facebook, X and Bluesky for the latest news.
The Citizen
29-05-2025
- Politics
- The Citizen
'Ramaphosa violating Genocide Convention on'Kill the Boer'
Ramaphosa said that 'Kill The Boer' is a 'liberation chant' and should not be taken literally. Lobby group AfriForum claims that President Cyril Ramaphosa's 'refusal' to condemn the chant 'Kill the Boer, kill the farmer' reflects double standards. Ramaphosa on Tuesday said that 'Kill The Boer' is a 'liberation chant' and should not be taken literally. It came a week after US President Donald Trump confronted the South African president by playing videos of EFF leader Julius Malema chanting 'Kill the Boer, Kill the Farmer,' using them to support his unfounded claim of genocide against whites in South Africa. In response, AfriForum argued that the ANC-led government's defence of the slogan, while passing judgment on similar rhetoric elsewhere in the world, highlighted inconsistencies in its interpretation of the United Nations' Genocide Convention. 'Double standards' The lobby group based its statement on evidence presented by Advocate Tembeka Ngcukaitobi, a member of South Africa's legal team, who led the genocide case against Israel at the International Court of Justice (ICJ) in January 2024. 'Ngcukaitobi argued that 'the intentional failure of the government of Israel to condemn, prevent and punish such genocidal incitement constitutes in itself a grave violation of the Genocide Convention,'' the lobby group said. 'Ngcukaitobi further argued that 'this failure to condemn, prevent and punish such speech by the government has served to normalise genocidal rhetoric' and has posed 'extreme danger for Palestinians within Israeli society,'' AfriForum said. AfriForum CEO Kallie Kriel described this as a case of 'double standard'. 'The ANC-led government's defence of the 'Kill the Boer' slogan, while passing judgment about similar calls elsewhere in the world as an intent to commit genocide, is evidence of double standards in their interpretation of the Genocide Convention. Kriel pointed out that 'farm murder deniers' are trying 'very hard to downplay the serious nature of farm murders' after Trump's meeting with Ramaphosa. 'AfriForum has always focused on the serious nature of farm murders rather than engaging in semantic debates about the term 'genocide' but believes it has now become necessary to test the actions of Ramaphosa's government against their own standards regarding the meaning of genocide'. ALSO READ: Piers Morgan slams Ramaphosa for defending 'Kill the Boer' chant [VIDEO] AfriForum defeat In March, AfriForum suffered a final blow in its attempt to have the controversial chant 'Kill the Boer, kill the farmer' declared as hate speech. The Constitutional Court (ConCourt) delivered a brief ruling dismissing AfriForum's application for leave to appeal. The Apex concluded that the application 'bears no reasonable prospects of success'. ALSO READ: WATCH: 'Dim the lights' — Ramaphosa pokes fun at Trump meeting
