FWA Codes of Good Practice and Tribunal rules

The collective effort from all industry players has led to the successful conclusion of the second output of the FWA programme, namely the Industry Codes of Good Practice and FWA Tribunal rules.

As a sign of commitment to the process, on 24 November 2022, stakeholders in the private healthcare sector, including co-regulators, medical schemes, administrators, and provider- and member associations, endorsed and adopted the Industry Codes of Good Practice (CoGP) and FWA Tribunal rules.

The CoGP represent a principled approach for prevention, detection, investigation, restitution, and penalisation methods to mitigate and manage FWA, whilst the Tribunal is a body established to resolve disputes in FWA-related matters according to Section 59 of the Medical Schemes Act (131 of 1998). These documents are backed by an FWA Charter, the industry-wide pledge to contribute to combating fraud, waste and abuse.

Looking forward to 2023, the CMS will continue with the FWA agenda that will bring into being Standard Operating Procedures for dealing with problematic claims, tools for monitoring and evaluation, detailed work on Tribunal operations and the development of relevant legislation.