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Section 59 Investigation

About the S59 Investigation

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Healthcare providers, represented by two associations, made public allegations about their treatment by medical schemes and administrators. They alleged that medical schemes and administrators were:

    • Racially profiling providers for investigation;
    • Applying invasive investigation methods;
    • Bullying and coercing providers to sign Acknowledgement of Debts (AoD);
    • Unfairly placing providers on indirect payment;
    • Unlawfully blacklisting healthcare service providers; and
    • Applying self-help tactics relying on section 59 of the Medical Schemes Act, (131 of 1998) (MSA).

The said complaints and allegations were also informed by how the medical schemes and administrators interpreted and applied the provisions of Sections 59 (2)(3) of the MSA and its related regulations.

The CMS commissioned an investigation on the above allegations which entailed:

  • Establishing a panel in June 2019, under the auspices of Section 7, 8 and 9 of the MSA led by Advocate Tembeka Ngcukaitobi SC, assisted by Advocates Adila Hassim and Kerry Williams.
  • Consulting with all industry stakeholders, the CMS, in its capacity as Regulator of the medical schemes industry, and
  • Contracting the services of an independent panel of experts with the view to investigate the allegations.

As expected, the Panel commenced with its inquiry which comprised of two main issues namely:

  • Racial discrimination by schemes against black health care providers; and
  • Procedural fairness of the treatment of black health care service providers.

While the enquiry may have comprised of the above main issues the scope of the investigation extended to assessing fraud, waste and abuse (FWA) to the extent that these were possible defences which were advanced by the medical schemes and administrators respectively.

As expected, the Panel considered, and reviewed the submissions and evidence of all stakeholders which culminated in the compilation of a draft interim report.

Latest Updates

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Notice 2/2023: Section 59 Investigation – Legal Submissions Virtual Hearings – 11 May 2023

This is an updated Notice, following the publication of another Notice on 9th May 2023. 

Please note that the Section 59 Investigation Panel has been briefed to consider the Interim Report’s comments and draft its Final Report. 

Download Notice here

Notice 1/2023: Section 59 Investigation – Legal Submissions Virtual Hearings – 9 May 2023 

 The Panel will convene a virtual hearing between 26-28 June 2023 (3 days). Should you wish to make legal submission please express your intention to do so by writing to the Secretariat. Any stakeholder who wishes to make oral legal submissions will be required to submit written legal submissions 7 calendar days before he/she/it is scheduled to present. 

Download Notice here

Section 59 Investigation Interim Report – 19 January 2021

Interim Report of the Section 59 Investigation

Download Report here

Contact the Panel

The Investigation Panel is completely independent of the Council For Medical Schemes, and all queries related to the Section 59 Investigation should be directed to the Secretariat/briefing attorneys of the Panel, Lawtons Africa.