The BHF has officially contested the CMS S59 Interim Report’s claims of racial bias in medical schemes, arguing on the grounds of procedural misunderstanding and the non-discriminatory nature of their processing algorithms.

The Board of Healthcare Funders recently filed its response to the CMS S59 Interim Report, following an invitation from the Panel chaired by Adv Tembeka Ngcukaitobi.

Represented by Adv Bruce Leech, the BHF argued why it disagreed with the panel’s findings, which said medical schemes were racially-biased towards black service providers.

At the crux of BHF’s argument is the fact that the panel looked at the sections of the Medical Schemes Act (MSA) in isolation but, critically, did not factor the onerous conditions that schemes have to adhere to in order to safeguard member contributions not only for current members, but also for future ones.

It is in carrying out this responsibility that members have to rely largely on automation to process the multibillion-rand claims relying on algorithms, which function on a code-based system. The service provider, the identity of a patient and the service rendered are anonymised and as such, there is no way of knowing the identity of a service provider.

The interim report also acknowledged that the algorithms are race blind, and yet the concluded schemes FWA where racially biased, it only considered the outcome but did not factor in the science behind it.

The BHF is of the view that until there is an alternative option to process the litany of claims that medical schemes receive each month, then the current method, which is an industry standard, cannot be faulted.

We reiterated our position to the panel that our members have no agenda to intentionally discriminate against any of the healthcare professionals, as we all share a zero-tolerance policy towards any forms of discrimination. Equally, we support efforts to root out fraud and wastage. (Click here to submission)