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Medscheme Denies Racial Profiling Following Draft CMS Report

Medscheme, South Africa’s largest health risk management services provider and largest managed care organisation, has categorically rejected claims that it performs any form of racial profiling when assessing or auditing healthcare claims.

Responding to the release of the Interim Report of the Section 59 Investigation Panel convened by the Council for Medical Schemes (CMS), Dr Lungi Nyathi, Executive Director at Medscheme, said: “We are extremely disappointed that we were not afforded an opportunity to review the Interim Report of the Panel before it was published publicly, as had been agreed. We shall now review the contents of the Interim Report and make a formal submission in response thereto.”

The company maintains that its duty will always be towards its beneficiaries to validate and verify healthcare claims, and the company does not take this duty lightly.

“Our fiduciary duty to safeguard funds entrusted to us remains to ensure that members and their dependants continue to receive access to healthcare treatment that is affordable and of the highest quality. This function has become even more critical in current depressing economic times, a function without which private healthcare would be substantially more expensive for everyone,” adds Nyathi.

Since the beginning of this process, the company has completed a few internal and external audits to make sure that its processes are beyond reproach. The company maintains confidence that Medscheme’s forensic processes are fair, transparent and within the law.