Medical aids ‘empowered

Dlamini Zuma ‘championed deregulation, which opened door to abuse of black doctors’.

THE financial abuse black private doctors suffer under medical schemes has been blamed on a 1998 decision by then health minister Nkosazana Dlamini Zuma to implement a deregulation law planned by the apartheid government.

Dr Norman Mabasa, a board member of the SA Medical Association (Sama), yesterday told the Section 59 inquiry that it was important to understand how medical aids ended up with the powers that they enjoyed. “History will help us understand where we went wrong,” Mabasa told the inquiry chaired by Tembeka Ngcukaitobi SC. Associations appearing before the inquiry held in Centurion, Pretoria, took turns talking about how medical schemes resorted to dirty tricks when they had to pay black private health practitioners. “The problem started in 1983 when minister Rina Venter pronounced that medical aids would be deregulated… in 1998, minister Nkosazana Dlamini Zuma gave birth to that pronouncement by deregulating schemes,” said Mabasa. Dlamini Zuma, serving under former president Nelson Mandela, championed the deregulation of medical aid schemes when amending the Medical Schemes Act, Mabasa implied. “This is where the deregulation, which was pronounced initially but not implemented by minister Rina Venter, became a problem,” he said. “When our minister Nkosazana Dlamini Zuma introduced this, they even nullified (tariff) negotiations which were there up to 2003.” These negotiations, meant to determine medical aid tariffs, were between private hospital groups, Sama and a defunct body, the Representative Association of Medical Schemes.

Leaving schemes to determine fees on their own created an environment for the abuse that was now being probed, said Mabasa. Schemes unleashed their “forensic investigators” on doctors who billed them a lot, he added. These were often doctors in communities with few private doctors and no white practices, Mabasa added. “The way they come to your practice is very inhumane because it is on suspicion that you’re earning a lot. It was as if they questioned ‘why are you earning a lot?’,” he said. Mabasa relayed an anecdote about an obstetrician who was hounded in 2003 because he was doing all the Caesarean operations in Giyani, Limpopo. “He was summoned to Randburg to account for why he was earning from Caesarean sections,” Mabasa said. “There are human beings in Giyani, children are born and this man was the only one who knew how to do Caesarean sections. “The other 10 or 15 doctors didn’t. But because he was the only one doing it, it was deemed to be fraudulent.”

Dr Aslam Vallee, 62, from KwaZulu-Natal, shed tears before telling the inquiry of the abuse that he had endured. Operating in a semi-rural area, he would see about 50 patients a day. Vallee said forensic investigators started to probe him when he claimed from medical schemes. Told to repay R300 000 to schemes, Vallee said he chose to launch a court challenge to prove that he was not guilty of fraud. He was slapped with more than 180 “trumped up” counts of fraud. After many appearances in court, the National Prosecuting Authority decided not to prosecute. “Even if you prove that you didn’t commit any fraud, their (scheme’s) action remains the same. They persecute you,” Vallee said. The inquiry continues today