GEMS faces scrutiny over costs, governance, and reserves
Parliamentary questions extend from fraud and outsourcing to trustee remuneration and benefit design, while the scheme’s reserves remain below the statutory requirement.
#fraudwasteandabuse
High Court upholds medical schemes’ recovery powers
The ruling preserves a key anti-fraud tool that industry bodies say protects member funds and helps contain healthcare costs.
Panel upholds findings of racial bias in medical scheme fraud investigations
Statistical analysis found that black healthcare professionals were multiple times more likely than their white peers to be investigated and found guilty of FWA.
BHF and Discovery challenge section 59 report’s conclusions
The Board of Healthcare Funders and Discovery Health say the panel’s final report on FWA investigations rests on flawed methodology and the misinterpretation of data.
CMS aims to release long-awaited report into racial profiling by year-end
Launched in 2019, the inquiry sought to investigate allegations of racial profiling by medical schemes. As 2024 draws to a close, the CMS is still battling objections and technical reviews to finalise the report.
Rise in complaints about medical schemes clawing back losses allegedly linked to fraud and waste
Schemes and healthcare professionals are at odds over whether these recoveries are justified, says the Council for Medical Schemes.
