Lee Callakoppen, Principal Officer, Bonitas Medical Fund
At a time when the healthcare system requires collaboration and trust to overcome the challenges we face fighting the Covid-19 pandemic, the Interim Section 59 Report may cause polarisation among stakeholders.
Bonitas has resolved to take a proactive approach to unceasingly evaluate its processes with regards to fraud, waste and abuse (FWA), following the release of the Section 59 Interim Report which raised several concerns of racial profiling and discrimination in the industry.
While the Section 59 proceedings were underway, we engaged in an independent analysis of the allegations through our governance structures, with oversight from the Board of Trustees.
Our analysis of claims data and irregularities is done on a data analysis level only, with no personal details of providers taken into account. This is overseen by a diverse and multi-disciplinary committee to review the analysis, prior to any investigative action commencing. This to ensure we make informed and fair decisions, free of favour or prejudice. Therefore, in light of the Interim Section 59 Report, we have undertaken to establish a Special Task Team, with the specific aim of independently looking into the findings of the Interim Report and re-evaluating our processes so that they do not ascribe to any form of bias.
While we acknowledge that fraud, waste and abuse is a key issue in the medical scheme industry and have actively acted to curb its purport, we do not support racial discrimination and prejudice in any shape or form.
The private healthcare industry has struggled with a prevalence of fraud, waste and abuse in the past decade, particularly as there is a lack of visible regulation and monitoring in this respect. As a criminal offence, healthcare fraud, waste and abuse not only tarnishes the good name of honest health professionals but is a grave injustice against medical scheme members, driving up premiums and depriving them of benefits.
Bonitas has a long and robust history of acting in the best interests of its members and rejecting racial biases, having been established in 1982 exclusively for Black, civil servants. Over the years, after becoming an open medical scheme, the Fund has become ideally placed for South Africans from all walks of life, offering a diverse range of plans and benefits.
We must stress that as the medical aid for South Africa, Bonitas aims to contribute to the improvement of the country on a socio-economic level and does not condone any form of racism or racial profiling. We will continue to analyse our processes and procedures to ensure that no there are no gaps or avenues for discrimination.
We welcome the efforts of the panel to ensure fairness but believe collaboration is needed across the healthcare sector to address the findings in a just and equitable manner.