Most medical schemes signed an industry charter on Friday to combat ‘fraud, waste and abuse’ in the private health sector said to total as much as R30bn a year, but the country’s doctors, hospitals and other service providers declined to sign.

According to Rapport, the charter promises better co-operation between all role-players to combat fraud, waste and abuse. One option discussed at the summit of the Council for Medical Schemes (CMS), where the charter was finalised, was to share information among medical schemes and to address ‘legislative gaps’ in medical coding and pricing systems.

The CMS said the last version of the National Health Reference Pricelist was reviewed in 2006 and as there is no uniform coding system, doctors took the initiative to develop their own coding systems. The Health Professions Council of SA, as the only body that can act against the majority of health service workers for unethical conduct, was not represented at the summit.

CMS Registrar Sipho Kabane said he was assured by HPCSA head Raymond Billa that the regulator would attend. Billa reportedly told Rapport he was ‘too busy’ as, being recently appointed, he was still finding his feet.

The SA Medical Association, which represents about 17 000 doctors, openly objected to the ‘narrative of the summit’ that health workers are often fraudsters and the main cause of waste and abuse. The doctors, hospitals, pharmacies and other industry bodies were specifically invited to sign the charter, but none did.

The report adds that the CMS is the custodian of the charter, but is under investigation itself for alleged fraud and corrupt relationships with some medical schemes. Kabane said the CMS had approached the Special Investigation Unit itself over the allegations and by doing so had proved it is serious about combating corruption.

Full report in Rapport (subscription needed)

See also a City Press report