Inquiry finds racial bias in medical aid schemes’ treatment of black doctors

An independent investigation has found evidence that some of South Africa’s largest medical aid schemes have unfairly targeted black healthcare practitioners, reinforcing longstanding complaints of racial discrimination in the industry.

The Section 59 Inquiry revealed that Medscheme, Discovery Health, and GEMS applied risk profiling that flagged black doctors as more likely to commit fraud, waste, and abuse than their white counterparts.

“This confirms what we have been saying for years black doctors are not treated the same,” said healthcare leader Dr Kgosi Letlape. “We need a system that is fair for everyone. We cannot have a system that unfairly targets certain groups of people.”

Black medical practitioners have long alleged that they face more frequent audits, delayed claim payments, and reputational harm based on unfounded suspicions. The inquiry’s findings appear to back these claims.

“Many of our members have been crippled financially because payments were withheld without proper cause,” said a representative from Mayibuye Consulting’s medical leadership. “When practices close, it’s the patients who suffer most especially in rural and township areas where options are already limited.”

The panel’s report warns that these practices not only harm providers but also compromise healthcare access for thousands of patients.

The Section 59 Panel recommended several reforms to address bias and improve fairness, including:

• An early warning system to alert providers of potential issues before punitive action is taken.
• Shortening the audit and clawback period to prevent financial ruin.
• Establishing an independent support mechanism for practitioners under investigation.
• Transparency in how algorithms and software decide which claims to flag.

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Political party ActionSA has filed a case against the implicated schemes and is calling for affected practitioners to come forward

“This is not just about doctors; it’s about protecting communities’ access to healthcare,” said an ActionSA spokesperson. “We are committed to fighting for fairness and accountability.”