9 July 2025 | 08:40 CAT
1-minute read

An independent panel has confirmed that South African medical aid schemes disproportionately targeted black healthcare providers for fraud, waste, and abuse (FWA) from 2012 to 2019.

The report, released after years of pressure, found “serious procedural shortcomings” in how medical schemes handle FWA cases. These include failing to inform practitioners of allegations in a timely manner, using opaque algorithms, and launching audits that go back more than three years.

The South African Medical Association (SAMA), a non-statutory and non-profit professional association for public- and private-sector medical practitioners, has welcomed the results of the investigation.

“These are the issues that are troubling us as the association,” Dr Mvuyisi Mzukwa, cHairperson of SAMA said. “We support the call… that there should be these legislative and regulatory and operational changes that must assist with eliminating discrimination and ensuring that there is fairness in the process.”

One of SAMA’s key demands is an immediate pause on all ongoing FWA investigations until a fair and transparent framework is developed. While critics warn this could give real fraudsters a loophole, Mzukwa insists the pause is necessary to prevent further harm.

“Some have lost their practices, some they’ve gone into mental illness, some they’ve lost their belongings,” he said. “So either way, you know, either parties are hurt in the process.”

The evidence of bias in the report lies not in overt racism, but in patterns and processes.

“Racism is very subtle,” Mzukwa explained. “So you have to look at the patterns and trends… even if you say there is no racial bias, there must be transparent processes that talk to fairness and justice.”

Medical aid schemes have reportedly disputed the findings, but SAMA stands firm in its call for systemic reform. As trust between healthcare providers and funders hangs in the balance, the demand is clear: end opaque systems, stop discriminatory practices, and rebuild fairness into the process.

Listen to the full interview on Sabaahul Muslim with Moulana Sulaimaan Ravat.