The Government Employees Medical Scheme (GEMS) told Parliament that it does not target black doctors based on their ethnicity during fraud investigations, reported Business Day (18 July 2025).
This follows a CMS report stating that the systems used by GEMS, Discovery Health and Medscheme are "procedurally unfair and disproportionately affected black practitioners”.
GEMS Principal Officer, Stan Moloabi, defended the scheme's methods stating that their fraud detection systems rely on practice codes, not race.
“The Practice Code Numbering System (PCNS) assigns a unique, non-demographic code to every healthcare provider in private practice, containing no information on age, gender or race. “The panel's investigation, however, used practitioners’ surnames as a proxy for race to reach its conclusions - a methodology contested as ‘unreliable and flawed’ by both Discovery and the Board of Healthcare Funders (BHF).
“The industry now awaits the CMS's decision on how to implement the panel’s recommendations and reshape the landscape of fraud investigation in South Africa's private healthcare sector.”
[BACK TO NEWS]