HPCSA Media Statement

 553 Vermeulen Street Arcadia, Pretoria PO Box 205 Pretoria, 0001 Tel: +27 (12) 3389300 Fax: +27 (12)  3285120 Email:  [email protected] Website: www.hpcsa.co.za <http://www.hpcsa.co.za/>

MEDIA STATEMENT

HEALTHCARE PRACTITIONERS' EXTORTION BY MEDICAL AID SCHEMES UNLAWFUL
FINAL
14 April 2010

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Pretoria - The Health Professions Council of South Africa (HPCSA) will not tolerate extortion by certain medical aid schemes. The unlawful practices by leading medical aid schemes have been brought to our attention by a number of healthcare practitioners.
The HPCSA has received information that certain medical aid schemes threaten, coerce and intimidate healthcare practitioners into signing acknowledgement of debt agreements where there are allegations of over-servicing of patients and/or claiming for services not rendered by practitioners registered with the HPCSA.
Medical aids begin their investigation by collating "evidence" (which remains untested) against a practitioner suspected of over-servicing patients and/or submitting claims in respect of services not rendered. The scheme then invites the practitioner to attend a "mediation meeting".

Untested evidence is presented and he/she is then given an ultimatum, or what is deemed to be a "once-off offer" to sign the acknowledgement of debt. The evidence against the practitioner is not made available prior to the meeting and his/her fist sight of the evidence is at the meeting. This can be overwhelming for anyone who finds himself/herself in such circumstances.
The practitioner could choose to either sign a plea settlement agreement (acknowledgement of debt) for an inflated amount of money, which is arrived at without any factual or scientific basis. Should the practitioner choose this route, he/she is then given an undertaking by the medical aid scheme that the matter is deemed to be settled between the parties and that no further action will be taken by the medical aid scheme.

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However, should the practitioner refuse to sign the acknowledgement of debt and/or defaults on any payment, he/she is "informed" (threatened) that:
1. a complaint will be lodged with the HPCSA relating to unethical/unprofessional conduct.
2. the contents and details of the matter will be circulated via the Forensic Management Unit (FMU) and the Board of Health Care Funders (BHF) meetings, for the attention of all their affiliated medical aid schemes;
3. that his/her details shall be added to the Medical Schemes Fraud database which is linked to Trans Union ITC;
4. that a criminal case of fraud and corruption shall be opened against him/her with the South African Police Services;
5.  the payment of any monies owing to the practitioner, by the medical aid scheme, is withheld for an undisclosed period of time; and
6.  any subsequent claims submitted to the medical aid scheme by the practitioner are paid directly to the patient, with the effect that the practitioner becomes responsible for the recovery thereof, from the patient.
The pressure placed on the practitioner at the meeting often leaves him/her no choice but to succumb to all the ridiculous requests of the medical aid scheme concerned.

These medical aids are taking the law into their own hands by applying unlawful tactics, acts of intimidation, coercion, threats and employing acts with are designed to cripple the practitioner's practice.

As a regulator, the HPCSA is empowered to investigate and prosecute acts of professional misconduct against practitioners when it receives complaints regarding practitioners who over charge patients and who defraud medical aid schemes, usually claiming for services not rendered or inflating claims.

The HPCSA would however, be abdicating its responsibility of guiding practitioners in line with its motto of "protecting the public and guiding the professions", if it did not offer any protection from this unlawful behaviour on the part of certain medical aid schemes.

The HPCSA advises that medical aids should rather pursue a claim against a practitioner using the normal civil remedies available to them to institute action for monies that are legally due or to report such deviant conduct by practitioners to the HPCSA.

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The HPCSA strongly condemns the unlawful conduct of certain medical aids that choose to negotiate with practitioners and agree that, in exchange for a settlement agreement, they will not report the fraudulent activities or unprofessional conduct to the relevant bodies, like the HPCSA.

In upholding its mandate to ensure healthcare practitioners conduct themselves ethically and professionally at all times, the HPCSA assures all parties concerned that practitioners who are found to have engaged in acts of misconduct will be investigated in terms of our disciplinary procedures and have appropriate penalties imposed where found guilty.
The HPCSA:

□ frowns upon conduct, where the organisation is used as a tool to threaten, coerce and harass practitioners into signing settlement agreements and where it is also used as a "debt collection agency", in the event that the practitioner default on their payments.

□ strongly condemns this practice as it is unlawful and amounts to nothing more than extortion.

□ is the only regulatory body in South Africa entrusted with the legislative mandate to discipline and impose an appropriate sanction on practitioners registered under the Health Professions Act 56 as amended, in instances where practitioners have been found guilty.

□ wishes to categorically state that medical aid schemes do not have any legislative mandate conferred upon them by either statute, legislation or an Act of Parliament to discipline and impose sanction on practitioners registered in terms of the Health Professions Act.

□ would like to urge medical aid schemes to follow the correct procedure and to immediately desist from such practice as it may amount to both unprofessional and criminal conduct.

□ wishes to confirm its stance that may form of misconduct including fraudulent behaviour and/or over-servicing will not be tolerated.

□ Remains committed to ensure that all practitioners registered under the Health Professions Act, practice their professions ethically, professionally and with dignity.