Panel upholds findings of racial bias in medical scheme fraud investigations
Statistical analysis found that black healthcare professionals were multiple times more likely than their white peers to be investigated and found guilty of FWA.
CMS
Medihelp’s solvency dips again, but scheme says recovery plan is working
Medihelp says its recovery plan is on track, with strong cost controls, younger members, and CMS-approved funding measures set to restore financial stability by 2026.
CMS will issue a new circular on appointment of healthcare brokers
A significant ruling by the Appeal Board rendered the processes outlined in the circulars published in 2022 invalid.
Major setback for medical schemes in legal battle over low-cost options
The Board of Healthcare Funders says it will appeal after the High Court dismissed its application on procedural and substantive grounds.
CMS extends exemption for primary healthcare policies
Insurers are allowed to offer primary healthcare policies for an additional two years pending the finalisation of a framework for low-cost benefit options.
Medical schemes push ahead with case over Covid test pricing
The Competition Tribunal has dismissed key objections from major pathology laboratories, moving the medical schemes closer to having their damages claim heard in the High Court.
Sanlam’s split with Bonitas paves the way for exclusive Fedhealth partnership
After months of speculation, Sanlam has officially partnered with Fedhealth as its exclusive open medical scheme provider.
Health Minister signals opposition to low-cost benefit options for medical schemes
In its long-awaited report, the Council for Medical Schemes says its preferred recommendation is not to introduce LCBOs.
BHF slams CMS report on LCBOs as flawed and politically motivated
The Board of Healthcare Funders questions the timing and content of the CMS’s report, claiming it ignores stakeholder input and the opposition to low-cost benefit options is politically motivated.
Minister proposes interim framework for collective healthcare tariff-setting
The Board of Health Funders has ‘serious reservations’ about giving the Department of Health the power to manage the block exemption negotiation process.
Discovery vs RAF: CMS executive says High Court got it wrong
A regulatory expert believes the judgment misinterpreted key legal principles in its ruling on the RAF’s obligation to reimburse medical schemes.
Court hears case on low-cost benefit options for medical schemes
The case raises questions about whether LCBOs will expand access to affordable private healthcare or threaten the rollout of NHI.
New chief executive and Registrar appointed for the Council for Medical Schemes
Dr Musa Gumede steps into the role of Registrar of the CMS, succeeding Dr Sipho Kabane, whose tenure was marked by significant challenges and critical industry reforms.
Bestmed defends 12.75% 2025 contribution hike as industry faces cost pressures
Bestmed states pending rules for low-cost benefit options have further complicated efforts to reduce costs for members.
CMS aims to release long-awaited report into racial profiling by year-end
Launched in 2019, the inquiry sought to investigate allegations of racial profiling by medical schemes. As 2024 draws to a close, the CMS is still battling objections and technical reviews to finalise the report.
Rise in complaints about medical schemes clawing back losses allegedly linked to fraud and waste
Schemes and healthcare professionals are at odds over whether these recoveries are justified, says the Council for Medical Schemes.
As medical schemes announce hikes, members brace for tough choices amid rising costs
With major medical schemes reporting average contribution hikes exceeding 9%, members face tough choices in an increasingly unaffordable healthcare landscape.
