Medical regimes reject claim that ‘racist’ algorithm flags more black doctors for fraud

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The Council for Medical Schemes has expressed concern about possible bias against non-white medical providers in the algorithms used by medical schemes to detect fraud.

Medical schemes cannot be blamed for trying to prevent possible misuse of their members’ funds and stamp out fraud where it is suspected, say lawyers for the medical aid representative body, the Board of Health Funders of Southern Africa (BHF).

Defending its members against the Section 59 Board of Inquiry, which reported in 2021 that there may be unfair racial discrimination against black medical providers, BHF attorney Bruce Leech, said administrators face onerous demands under medical plans law to preserve medical aid assets. However, the panel’s interim report completely ignored this, Leech said.

The panel has yet to release its final findings, despite releasing a damning interim report in January 2021, saying evidence showed Discovery, Medscheme and the Government Employees Medical Scheme (GEMS) were more likely to report providers of black services guilty of fraud, waste. and abuse. The panel reviewed cases between 2012 and 2019 and reported a “substantial difference” in fraud, waste and abuse outcomes between black and non-black practitioners.

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