Discovery Health admits its system is prone to flag black doctors

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Hearings into allegations that medical aid schemes are racially profiling black and Indian medical practitioners continue in Centurion on Thursday.

Medscheme will make its submissions.

On Wednesday, Discovery Health was in the hot seat.

It denied claims that it targets black medical practitioners for fraud, waste and abuse investigations.

The company has, however, admitted that there are disproportionate investigations of black professionals.

The medical aid giant says its system is more likely to flag and investigate black medical practitioners than their white counterparts because there have been cases where doctors committed crime to assist poor patients.

“We do feel that there is no evidence of the allegations made against us that’s come before you,” Discovery Health CEO Dr Jonathan Broomberg told the hearing, refuting claims of racial profiling.

The company says fraud, waste and abuse are the main drivers of claims. It says it works on tip-offs and red-flags on the firm’s system.

Chairperson of the Section 59 Investigation Advocate Tembeka Ngcukaitobi wanted to know why only black practitioners are likely to be investigated. “Is your submission that black doctors are more likely to be identified as fraud waste and abuse cases because they are trying to commit fraud in the process of trying to help poor people?”

In his response, Broomberg said: “I don’t think I can go so far as to say that either than to say that it is possible that when you look at the doctors who are serving the relatively lower income families within medical schemes, it is possible that a higher proportion of those doctors are black.”

Dr Donald Gumede from the National Health Care Professionals Association, which raised the issue of racial profiling, believes the truth is finally coming out.

“I would be happy if that gets corrected with strong recommendations because I believe that medical aids just made this fraud and waste and abuse a business and it shouldn’t be. If there is a crime that is committed you should try to prevent it and stop it, but I believe that the means that they have been using it as means to create criminality, which is not good.”

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