CMS moves to rein in how medical schemes investigate fraud
Circular 10 introduces interim rules to standardise audits, investigations, and clawbacks as broader reforms are developed.
CMS
Bonitas-Medscheme court battle stalls as application removed from urgent roll
Medscheme’s bid to halt Bonitas’ administration transition has been delayed after procedural lapses and unresolved interlocutory issues forced the matter off the urgent roll.
Tensions rise as Bonitas and Medscheme clash ahead of court showdown
Bonitas, Medscheme, and PHA trade accusations as court papers, whistleblower claims, and a CMS probe intensify the battle over medical scheme contracts.
Sizwe Hosmed: High Court blocks board comeback, new curator installed
The CMS frames the judgment as necessary to protect members, emphasising the scheme is compliant, operational and under close oversight.
Bonitas-Medscheme split: what the CMS probe means for members
The scheme and the regulator say a narrowly focused investigation will not halt the transition – but members should brace for some operational changes.
CMS says GEMS cannot cut 25% reserve requirement
The comment comes amid a growing standoff between organised labour and GEMS after the scheme announced a 9.8% contribution increase for 2026.
MediCheck claims win as Discovery Health writes off up to R170m in ATB recoveries
Discovery Health has abandoned recovery action against more than 16 500 members, agreeing to absorb up to R170 million in overpaid ATB claims after sustained pressure from MediCheck,
CMS steps in as Discovery Health begins recovering pharmacy overpayments
Discovery Health is engaging affected members individually after a processing error led to some pharmacy claims being paid beyond Above Threshold Benefit limits during 2025.
‘Medical schemes face structural strain as claims growth outpaces contributions’
The 2024 Industry Report highlights rising utilisation, ageing membership, and persistent under-pricing as the key forces reshaping medical scheme sustainability.
Eleven schemes account for nearly 90% of broker fees
Broker service fees made up 17.65% of medical schemes’ directly attributable insurance service expenditure in 2024.
Bonitas commits to co-operating with CMS investigation
After concluding its section 43 inquiry into Bonitas, the CMS has determined that the allegations merit a further forensic investigation.
CMS: No complaints about brokers’ conduct in 2024/25
The Council for Medical Schemes’ latest annual report shows a decline in registered complaints – continuing a three-year downward trajectory.
Consumer Goods Medical Scheme launches new options as it opens to entire sector
The Council for Medical Schemes has approved two savings plans that will be marketed from 1 November.
CMS research points to urgent need for chronic disease and cost-of-care reforms
Two new CMS studies highlight the growing strain of chronic diseases and soaring out-of-pocket healthcare costs.
High Court confirms curatorship of medical scheme
The Court ordered Sizwe Hosmed’s principal officer to personally pay legal costs after dismissing the scheme’s attempt to overturn the provisional curatorship.
Discovery delays 2026 contribution increase to April
Leading open medical schemes have announced increases above the CMS’s guidance, underscoring the tension between regulator calls for restraint and schemes’ funding needs.
Provisional curator to advise on future of medical scheme
The curator will assess Sizwe Hosmed’s finances and recommend whether it should merge, be liquidated, or continue.
