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Extortion or self-defence? - tempers rise in claims row

Chris Bateman

Abstract


Are embattled medical aids indulging in bully-boy ‘extortion’ tactics or merely recouping losses from suspect health care practitioners whom the industry claims cost it R7 - R10 billion (10% of payouts) in fraud, abuse or over-servicing every year?
The issue of suspect health care practitioners being pressured to sign once-off ‘acknowledgement of debt’ notes to avoid potentially ruinous criminal and business censure was brought centre-stage by the Health Professions Council of South Africa (HPCSA) last month.

Without naming anyone, it publicly slammed ‘a large number of leading medical aids’ for what it termed ‘criminal extortion’ or ‘acting as debt collection agencies’ whenever health care practitioners were suspected of over-servicing or fraud.
HPCSA spokesperson Bertha Peters-Scheepers said that over the ‘last couple of months’ the Council had received a surge of “at least 20” complaints from aggrieved doctors. The South African Medical Association (SAMA) backed the HPCSA, saying that while it did not condone fraudulent activities, it had ‘always been concerned’ by the investigation ethics of schemes that so often soured doctor-patient relationships.

Author's affiliations

Chris Bateman, HMPG

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Keywords

Medical Aids claims, overservicing

Cite this article

South African Medical Journal 2010;100(6):338-340.

Article History

Date submitted: 2010-05-05
Date published: 2010-06-01

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