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Medical schemes R13bn fraud problem might be solved with AI

Medical schemes R13bn fraud problem might be solved with AI
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Healthcare

As the medical scheme industry aligns itself along a person-centric health ecosystem, it is also key to recognise and acknowledge the people in the sector who work tirelessly in providing exceptional service.

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Gems, BHF lose bid to halt report containing scathing allegations of racism

Siyanda Ndlovu The independent panel also found that medical aid schemes and administrators were withholding payments to black and Indian doctors on the perception of fraudulent claims. Picture for illustration: iStock The report was due to be released on Sunday, only to be blocked by Gems and BHF’s urgent application at the 11th hour. Ngcukaitobi, advocate Adila Hassim, and Kerry Williams were appointed by the Council for Medical Schemes back in 2019 to probe allegations by the National Health Care Professional Association (NHCPA) of unfair treatment by medical schemes. Gems filed the application urgently stating that the report was halted because it was going to seriously harm its reputation.

South africaAdila hassimTembeka ngcukaitobiKerry williamsNational health care professional associationPretoria high courtCouncil for medical schemesHigh courtGovernment employees medical schemeHealthcare funderPretoria highMedical schemesகெர்ரி வில்லியம்ஸ்தேசிய ஆரோக்கியம் பராமரிப்பு ப்ரொஃபெஶநல் சங்கம்ப்ரிடாரீய உயர் நீதிமன்றம்சபை க்கு மருத்துவ திட்டங்கள்

Degrading, humiliating, distressing – report finds medical schemes racially profiled black doctors

Panel investigating claims of racism against Medical Schemes ‘Degrading, humiliating, and distressing’ – Section 59 investigation finds medical schemes racially profiled black health practitioners. The findings of investigation stemming from allegations from black doctors were released this week, despite attempts to block in in court. Note- this story has been updated since it was published to include Discovery Health comment – Court action could not keep the damning findings of racial profiling of black doctors by medical aid schemes from public view. A High Court judge has handed down a ruling ordering that a report revealing Medical Schemes racial profiling of doctors and health workers should be released to the public.

South africaTembeka ngcukaitobiKaryn maughanJonathan broombergColleen collisXoli mngambi xolimngambiDesmond lathamA high courtNational health care professionals associationDiscovery healthPretoria high courtCouncil for medical schemesMedical schemesHigh courtGovernment employees medical schemeHealthcare funder