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Medical schemes’ investigators terrorised black, Indian doctors, inquiry told

Picture: iStock

Picture: iStock

Dr Aslam Vallee testified that even if innocence was proven, the persecution and harassment continued.

The inquiry into the alleged unfair treatment of medical practitioners by medical aid schemes heard yesterday the regulator, the Council for Medical Aid Schemes (CMS), had done nothing when medical aid schemes targeted black and Indian doctors for perceived fraud.


Advocate Tembeka Ngcukaitobi and his panel are probing allegations of racial profiling and withholding of payments to black and Indian doctors by medical aid schemes.

The inquiry, sitting in Centurion, yesterday heard that medical schemes administrators’ forensic investigators terrorised black and Indian doctors.

They told the inquiry that, for over a decade now, their practices have been haunted by investigators whose goal was to brand them corrupt and withhold payment then bully them into signing acknowledgement of debt.

Meanwhile, CMS and the Health Professions Council of South Africa (HPCSA) had proved to be toothless.

“The HPCSA knew as far back as 2010 about this extortion racket. This is not new. This issue was communicated to the CMS but nothing was done.

“The CMS does not understand the law. If they did, they would have made the medical scheme pay me,” KwaZulu-Natal general practitioner Dr Aslam Vallee told the inquiry.

The doctors also said the medical aid schemes’ investigators demanded their targets proved they had no fraudulent claims, insisting on getting information from as far back as four to six years.

Dr Vallee testified that even if innocence was proven, the persecution and harassment continued. This was because the real purpose was to ruin them, he said, adding that some practices were targeted simply because they had a lot of patients.

Mvuyisi Mzukwa, SA Medical Association vice-chairperson, said the biggest problem faced was the lack of a referee for disputes between medical aid schemes and medical practitioners.

The CMS, which he said was supposed to keep the medical aid schemes in check, denied this was their mandate.

“They said their mandate was between patients and the medical aid schemes.”

He said the medical schemes administrators’ investigators were “a law unto themselves” and “cannot be allowed to operate like some rogue unit”.

The head of the Independent Practitioners Association Foundation, Dr Elijah Nkosi, told the inquiry of an instance when investigators had tried to entrap black doctors into wrongdoing and then charge them.

The Alliance of South African Independent Practitioners Associations submitted that the investigators were only interested in information proving guilt and not in proof of innocence.

Chief operating officer Henru Kruger said three out of five cases they dealt with either involved blacks or Indians.

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