Motsoaledi says ‘no excuse’ for racial bias by medical schemes
Health Minister Dr Aaron Motsoaledi has called for urgent legislative reform and stronger accountability after the release of a damning report.
The report confirmed that black healthcare providers were systematically targeted by medical schemes under the guise of fraud investigations.
Addressing Parliament's Portfolio Committee on Health on Friday, Motsoaledi said the final report of the Section 59 investigation panel — chaired by Advocate Tembeka Ngcukaitobi — had confirmed that medical schemes unfairly profiled and penalised black practitioners between 2012 and 2019, often without due process.
“The Act is silent. It does not indicate the steps that schemes must take when investigating fraud. So they invented their own methods — unfortunately, those methods were tainted by racial bias,” said Motsoaledi.
“Even in a democracy, nothing can justify discrimination. Not even silence in legislation.”
The report, finalised in April 2025 and first initiated in 2019, found that schemes like Discovery Health, Medscheme and the Government Employees Medical Scheme (GEMS) disproportionately flagged and financially penalised black professionals for alleged fraud, waste and abuse (FWA) without sufficient evidence or transparent processes.
Despite being given four years to respond to the panel’s preliminary findings, the minister said the schemes failed to adequately justify their practices.
“The panel said clearly: they were not convinced by the responses. Hence, the final report was released in April this year.”
He told MPs that the Department of Health would now seek legal advice to assess options for redress and possible amendments to the Medical Schemes Act, but said immediate focus would be placed on implementing protections for current practitioners.
“There are three levels of recommendations: one, schemes must revise their algorithms and practices. Two, the Council for Medical Schemes must introduce regulations to ensure fairness. Three, Parliament may need to amend the law to define what medical schemes can and cannot do.”
The minister also confirmed that although the panel’s findings were not legally binding, they highlighted serious regulatory gaps.
“They were not a court of law. Their task was to determine if discrimination had occurred — and they found that it had.”
The report has sparked calls from healthcare providers and civil society groups for restitution, transparency and transformation in the private health sector.
But Motsoaledi cautioned against rushing punitive action without due legal process.
“We live in a constitutional democracy. Penalties can’t just be made up — they must be rooted in law.
“We believe Parliament has a duty to act,” Motsoaledi said. “The integrity of our healthcare system depends on it.”
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