The Council for Medical Schemes (CMS) and the Section 59 Investigation Panel have announced that the final report on the Section 59 Inquiry is “close to completion and will be released and published as soon as possible”.
In 2019, the CMS, with the concurrence of the Ministry of Health, launched an investigation into claims by members of Solutionist Thinkers and the National Health Care Professionals Association (NHCPA) that black medical professionals were treated unfairly and schemes withheld their claims because of racial profiling. Allegations included racism, blacklisting, clawbacks, and the targeting of black professionals.
On 25 June 2019, the CMS published a circular setting out the Terms of Reference (TOR) for a section 59 investigation panel.
The panel’s interim report was released in January 2021.
In a media statement released this week, the CMS and the panel stated they were aware that healthcare practitioners, schemes, and administrators were awaiting the finalisation and publication of the panel’s final report relating to its investigation into allegations of, inter alia, racial profiling and unfair investigation processes.
According to the joint statement, final expert and legal submissions by Discovery Health and Discovery Medical Scheme, received in February and March, were being taken into account by the panel in its deliberations.
“The body of evidence and the legal submissions are extensive and require time for proper analysis and consideration. The CMS and the panel request the indulgence of all stakeholders and interested parties and reiterate that the finalisation of the report remains a high priority,” the statement read.
The most recent call for confirmation on when the final section 59 investigation report will be released came via a leaked lawyer’s letter sent to the CMS by the Board of Healthcare Funders (BHF).
The BHF, a non-profit organisation, represents about 40 schemes and medical scheme administrators, serving roughly 4.5 million beneficiaries.
The letter, dated 16 February 2024, was sent by Bowman Gilfillan, acting for the BHF. In the letter, the BHF takes the Registrar of Medical Schemes, Dr Sipho Kabane, and the CMS to task over 10 issues, including the delay in the release of the final report on discriminatory practices.
Read: Board of Healthcare Funders takes Council for Medical Schemes to task in lawyer’s letter
According to the letter, the TOR indicated that the intention was for the panel to complete its work within four months and that a final report would be delivered by 1 November 2019.
“Our client still awaits a final report although it has been more than four years since the process started with no end in sight. The way the investigation is being handled, in particular, the ill-informed further information requests, is perceived as an attempt to victimise medical schemes at the expense of their members and for ulterior purposes outside of the Council’s scope,” the letter read.
In a scathing 31-page response released on 26 April, the Office of the Registrar dismissed the BHF’s claims as “baseless allegations”.
“Whilst we readily admit that there have been delays in the release of the final report of the Section 59 investigation, these have been outside the control of the CMS and evidence will support this assertion,” the response read.
Read: CMS invites BHF to collaborate, criticises ‘forum-shopping’ tactics
The CMS further “vehemently” rejected the notion that the Section 59 investigation was a waste of public funds and stated it was “extremely disturbed that the BHF is using the media to trivialise allegations of bullying, coercion, and blacklisting of black health professionals”.
“BHF was part of Section 59 steering committee and Section 59 investigation is a matter of public interest in the post-apartheid South Africa,” the response read.
It went on to say that the final report was expected to be delivered in May.
