Neelam Rahim | neelam@radioislam.co.za
3-minute read

📷 Discovery Health has reversed clawback demands on thousands of members after an administrative error, following swift intervention by Medicheck SA and regulators.

Thousands of Discovery Health members have received relief after the medical scheme reversed its decision to claw back tens of thousands of rands from members for overpayments, they were not responsible for. The decision follows urgent intervention by Medicheck SA and the Council for Medical Schemes (CMS).

The controversy emerged after approximately 16 500 Discovery members were issued with repayment demands, in some cases exceeding R80 000, for medicine claims dating back to 2025. Members were informed that these payments were made in error and needed to be recovered.

Speaking to Radio Islam International, Medicheck SA CEO Mark Hyman said the issue stemmed from a system error within Discovery’s administrator. “During January 2025, Discovery started making changes to their systems. Somewhere in that process, an error occurred in the coding within the programs at the Discovery administrator,” Hyman explained. He stressed that members had no way of knowing that claims were being overpaid. “As an average consumer, you assume the medical aid has made changes to its systems and is therefore paying for these claims.”

Hyman questioned how the issue went undetected for most of the year. “A company filled with actuaries would have seen a dramatic growth in medicine claims being paid,” he said, adding that Discovery only began investigating the matter months later.

Medicheck responded swiftly after receiving close to 1 500 complaints from affected members. “We acted on a collective or class action basis for the members,” Hyman said. Emergency letters of demand were sent to Discovery, naming both the administrator and the scheme’s trustees. “The trustees have a fiduciary duty to ensure that members’ funds are correctly managed, and that duty was totally maladministered,” he added.

The turning point came after regulatory intervention. Following a meeting between Discovery and the CMS, Discovery confirmed on Sunday morning that it would abandon the clawback process. “The pressure was too strong and the reputational risk too high, and they capitulated,” Hyman said.

He has since called for a possible Section 44 investigation, which would entail a full forensic audit of both the scheme and the administrator. “It’s a statutory process designed to protect members’ interests and identify any other errors that may have occurred,” he explained.

Hyman advised medical aid members to never ignore recovery demands. “Don’t just sit on it. Query it with the scheme, and if you get no satisfaction, approach an industry watchdog,” he said.

The reversal has been welcomed as a victory for consumer protection, highlighting the importance of oversight, accountability, and swift regulatory action in safeguarding medical aid members.

Listen to the full interview on The Daily Round-Up with Moulana Junaid Kharsany and Mark Hyman.