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Tonight with Jane Dutton | Are medical aid schemes racially targeting people? | 15 May 2019

thanks Michael a black and Indian private medical practitioners say they're struggling to get payment from medical aid schemes they say this is because of the color of their skin the practitioners claim this unfair treatment sets their practices up for failure and puts their patients at risk medical aid schemes passing around lists of practitioners to boycott based on race my guest tonight chairperson of the national healthcare professionals Association dr. Donald gamma-d chief executive at the Council for medical schemes Dr Seberg Ambani and clinical social worker nama Fezzik attorney who was a victim of mistreatment from medical schemes very good to have all of you join us we start off with you and you say you were a victim what happened um what is happening we I get audited every two years I get audits and normally the medical aid which is discovery on my side they will demand the confidentiality of my patients to be submitted so that they can start to audit the minute I refuse to give them the confidentiality of the patient then I'm told that okay if you don't agree with that we're gonna pay the patient and the patient will pay you and guess what happens now a patient will receive the money and don't pay me or a patient will decide that your services are good and I want to come back they pay sort of been struggling that over two years yeah over the past two years is that even legal I mean asking for those sort of requirements medical schemes and administrators to ever responsibility of making sure that the funds that have been contributed by members are not illegally claimed so they are certain measures that they are allowed by the Act you know to make sure that they verify the claims and make sure that they are legitimate but once that has been done they're supposed to actually pay that and you know but but we don't encourage and we don't support the view that people can demand to see confidential clinical information of patient because that's unethical it's like a professional ethics course bullying yes and it's bullying and you you know it's it's problematic for for professionals there are certain circumstances that allow you to provide and disclose this information and and and these special circumstances or veneers are P not by legitimate court or indeed you get permission from the patient's themselves that says they do not mind but obviously there has to be a valid you know reasonable reason why you want to do that your media in your experience you say that it's it's been happening for years and tell us more about the racial profiling what makes you claim such a thing yeah it's because we have evidence and that's that evidence we submitted it to the other stations where we invited what is the evidence we have a list that we submitted of over and it's mainly black people who are there and Indians and one front of mine said I must mention that also coloreds so the problem that we're having is the medical aids have become law unto themselves and the person who's supposed to be looked after who is the patient has been forgotten so now they take money from the patients they don't pay them they don't pay for their services patient are suffering I had a harrowing experience even today from one journalist who who called me to say you know dr. pomatter what you were saying on Monday it happened to me because the people in my area they refused to take Medicare certain medically discovered the doctors refused said we're not gonna see you now these things they affect the patient then are not only affecting the healthcare practitioners but it also impact heavily on the patient because that patient would have died would have taken the responsible the medical it won't you have taken the responsibility of that and you think the medica is not taking the responsibility because mainly the Pratt stationers are black indian or colors yes correct hundred percent I mean I've been have a reason to be making this sort of judgment call I mean how could they possibly justify such a thing yeah what is happening or what we've been observing and some of the colleagues will even share with us the miniature practice starts to boom you like you for audits and some of my colleagues have told me that you know what if he at it during the interviews they we were told it why is your practice growing so fast so you get such kind of questions and I also wanted to respond to doctor Cavani when it comes to patients confidentiality the only time we are allowed to read to reveal or disclose that information is when the patient is threatening to harm herself or harm others or when the court is subpoena you we cannot say to the patient for example we we take a contract when you see a patient to say whatever we discuss here NCA so I cannot abuse that right of a patient because I say I just said whatever we discuss here ends here and on the other side I go to the patient can I access your files because the medical aide wants your files so it's like imposing dubious was happening that they'd be able to get it from any other area other than this your patient yes so you you you don't want to contradict yourself at the same time you don't want your patients to be vulnerable cuz they're they're already vulnerable the fact that they came to my practice so imagine when I go back and say the medical aid needs your file what is the patient see what do they think they start to think and feel sorry for me and they say they may have that is even wrong so I don't stand with it okay I just want to say that we did extend an invite to med scheme medical aid and the government employees medical scheme and both teams say that they are meeting with the health minister or in maxillary in to discuss the matter on Thursday and reserve the right of response until then and this is what discovery said they discovery self sent us a statement dismissing these allegations it says the company is against any sort of discrimination against any health care professionals you shaking your head no yes I am shaking my head because you see I've been to discover a special day themselves they've got these secret rooms that's why I said file plus in in the interview that I had they've got these secret cubicles where they call profit kept professionals with these forensic people and then they sit around you and pressurize people to sign acknowledgement of depths you see and then they say to you the hold on your payment which is illegal they hold on your payments and ecology says ok we have all done your payment is two hundred thousand if you pay us eighty thousand and we'll release the payments to me that's that's blackmailing and if and if you don't pay us we're not going to release the money and we're gonna tell our patients not to come to you what do you think is going on here I mean I know that there is a problem that that there are some doctors that there are some patients who did all the books and try a new misc scan medical anything however they do that but this is surely not the right way to get around no that's correct I mean if you look at the Act itself particularly the relevant section you know section 59 of the Act and you know regulation five and six no way does it empower medical schemes or regulators to do some of the acts that we've been told they are happening like racial profiling black listing of doctors keeping lists of doctors or professionals that are not satisfied yes why cameras equation the pooling as a regulator we we absolutely are not in support of those acts because we believe they are unlawful and they compromise rights that people have been accorded through the Constitution what we believe in is that schemes and administrators yes they've got a responsibility to ensure that payments that are made a valid the legitimate but where they pick up problems there needs to be a process of engagement with the relevant service providers in order to find a solution I should imagine this is where the regulator's should be stepping in and and clearly not and the country has these you know agencies where for instance if you believe this UNAC a fickle and unprofessional conduct that case should be correctly referred to the health professional Council of South Africa true if it's a violation of the medical schemes Act and its regulations then it falls under our jurisdiction but we're clearly you think there is fraud there's also laws like the prevention of fraud you know that compel any of us that if you see fraud being perpetrated and it's always a certain amount you need to report that if you don't report then you're complicit so so we expect schemes and administrators to adhere to all these exactly laws and not take matters into their own hands what sort of impact does it make on your practice and your reputation because people must know surely you know talking of the reputation my reputation is at stake with patience because now the patient is has received money and you're trying to get the money from the patient the patient will tell you no no I'm not gonna pay back or the patient will run around and tell you all the stories if you insist you get a lot of threats from patients whereby they would say I'm gonna tell the medical aid I didn't see you sir right yes I'm gonna claim that you didn't see me I'm gonna claim that you you you you know they they claim things that you start to wonder that you know what this is just making it's pulling me down on the ground they'll create a lot of stories but then at the same time that had been working with patients I will say 80% of the patients were very loyal to my services okay I mean let's let's stick with money because medical aid schemes obviously they make millions every month it's been reported that their reserves are eight percent above what the law requires and yet they won't allow members to choose their own preferred health Pratt patience what's in it then and if the money is there you wonder why they they're playing the sort of game thank you you know the one thing that the public don't know is that there is a medical aid and there is an administrator the medical aid has supposed to been nonprofit organizations I'm gonna stop you there for a minute because I want us to hear what was said the data at our disposal shows that medical schemes are holding in reserve as I'm speaking now close to 60 billion runs that is not being used granted of course there is a statutory requirement in requirement by law that medical schemes should have 25 percent of their income in reserve because this is to Keita for emergencies but our problem our bone of contention is that this 60 billion rand is equivalent to 33 percent reserves which means unnecessary accumulation at the expense of patient care under trachomatis so what is at play at this point in time and that's why we requested a commission of inquiry it's a symphony of money from one space to the to the rest to the other one the man is taken from the patient in the medical in the medical aid kitty transferred to the administrator was supposed to be admitted in that man on behalf of the of the scheme their papers that administrators is to make sure that what dr. McGovern was saying make sure that the money is paid to the right provider so service providers but what there has become now this the schemes to what I've done they collect the money from the patients and they collect the money from their kept practitioners that's why they've got so much reserves and they've got so much money because in truth if I'm paying this acknowledgement of depth that I'm talking about it means I'm paying somebody else salary somebody else have professional salary and the medical aides are not paying anybody let me say that mr. it has to be to be precise yes it's a Ponzi scheme yes so the money actually it doesn't go out me that it gets in it doesn't go out it sits there in the system and then that's why even when the interview they tell them what about the Commission nobody wants the Commission because they will and f this what we're talking about we are not paid we are not saying and we it is a disclaimer like you rightfully said in any institution there will be those bad elements but this is not my bad elements issue it's about them making money from health care professionals okay so what happens now because clearly who's ever supposed to be regulating this is not doing the job correctly and people are suffering innocent people where to from here yeah well from here with with all these allegations that are out there in the in in the open we believe these are serious we are going to be collecting the information like the lists that were told are out there we're going to investigate and verify all these allegations you know include the correspondence between schemes and administrators and service providers we're also going to look at all the complaints that are related to this section of the Act in order to make a determination of which of these allegations actually has got an element of truth in them but obviously as a religious leader the the medium to long term strategies actually to resolve all of these and make sure that once we condemn fraud waste and abuse on the side of service providers we spend the same energy ensuring that administrators and schemes you know also keep to their side of the lawyer but can I just add here that whilst you've got schemes that are self administered and schemes that have contracts with administrators it is very important to note that the schemes themselves do have governance and our expectations as regulators is that those power of trust easy are the ones that are supposed to be asking these difficult questions very briefly just if you could yes no are you going to the meeting with the Health Minister have you been asked yes yeah tomorrow tomorrow at 10 o'clock we will be actually being convened by the constant America the results dr. Bonnie and Katrina thank you very much for joining us now here's one for an awkward moment at a dinner party when you've got nothing to say did you know that every person sees their own rainbow and the number of colors will defer to the reason is a rainbows light that's bent and reflected by raindrops and those angles will be different for everyone even if someone is standing right next to you looking at the same rainbow and by the way you'll never reach the end of that rainbow to get that gold since it is an optical illusion it'll always be the same distance away from you all the time that's our show for tonight news is next see you then

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